颈椎动力位MRI在颈椎病临床诊治中的作用

目的通过颈椎动力位MRI检查测定颈椎病发生发展中的静力性和动力性因素，探讨动力位MRI埘颈椎病早期诊断并早期干预、手术治疗的指导意义。方法对15位被检者行日本骨科学会（Japanese Orthopaedic Association，JOA）评分、颈椎X线及MRI检查．测量Pavlov比值、腹背侧蛛下腔矢状径、脊髓及蛛下腔正中矢状径、脊髓及蛛下腔面积，蛛下腔狭窄度分级，计算脊髓／蛛下腔矢状径比、面积比．进行过屈、中立、过伸3种体位间比较。将JOA评分与部分测量指标进行相关性研究。结果Pavlov比值示8例骨性椎管狭窄。腹背侧蛛下腔狭窄程度在过屈位有一定缓解，过伸位有一定加重；过屈位与过伸位问差异有统计学意义（P〈0．05）。JOA评分与Pavlov比值、面积比有相关性。结论颈椎动力位MRI能反映颈椎在屈伸位变化时内部结构的变化，对临床诊断、干预及手术均有一定的意义。

Effect of cervical kinematic MRI in diagnosis and treatment of cervical spondylosis

Objective To investigate the static and kinematic factors of the pathogenesis of cervical spondylosis and explore values of kinematic MRI in clinical diagnosis,treatment and surgical operation of cervical spondylosis.Methods A total of 15 symptomatic subjects were involved in this study,whose Japanese Orthopaedic Association(JOA) scores were recorded and cervical X-ray and kinematic MRI examinations were performed.Pavlov’s ratio,sagittal diameter of ventral and dorsal subarachnoid space,subarachnoid space,spinal canal,area of cross-sectional spinal cord and subarachnoid space were measured.The grade of stenosis of subarachnoid space was evaluated.The ratio of sagittal diameter and area of spinal cord and subarachnoid space were calculated.The differences of these datas among the 3 positions(flexion,neutral,extension) were investigated.The correlations between the JOA score and part of datas were investigated.Results Pavlov’s ratio demonstrated stenosis of bony spinal canal in 8 subjects.In kinematic MRI,the grade of stenosis of ventral and dorsal subarachnoid space in some segments were released in flexion and aggravated in extension.The difference between 2 position was statistically significant(P<0.05).There were correlations between the JOA score and Pavlov’s ratio,ratio of area.Conclusion Cervical kinematic MRI can reflect the changes of cervical structures during the different positions,it is useful in diagnosis and treatment,including the surgical operation of the cervical spondylosis.