颈脊髓受压程度与椎间隙及颈椎曲度变化的相关性研究

目的:探讨颈脊髓受压程度与性别、年龄、椎间隙及颈椎曲度变化的相关性,应用多元线性回归方法建立预测颈椎病患者颈脊髓受压程度的模型。方法:选取颈椎病患者120例,按照脊髓受压程度分为4组,在颈椎矢状位MRIT2WI成像上测量颈脊髓受压比例,椎间盘后凸顶点脊髓矢状径（a）、延髓与桥脑交界处矢状径（M）,计算a/M值来评估颈脊髓受压程度;在颈椎X线侧位片上测量相应节段椎间隙前后柱高度、椎间隙夹角以及颈椎曲度(颈椎曲度采用Borden’s测量法和C_2-7Cobb角双线法);采用线性回归和多元线性回归分析上述各测量值之间的相关性,建立预测颈椎病患者颈脊髓受压程度的模型。结果:①各测量值随着颈脊髓受压加重而逐渐减小,椎间隙前高、椎间隙角度、a/M比值4组间两两比较差异均有统计学意义（P<0.05）。②a/M比值与椎间隙前高呈正相关（R=0.296,P<0.001）;a/M比值与弧弦距（颈椎曲度）呈正相关（R=0.241,P<0.001）;a/M比值与颈脊髓受压比例呈负相关（R=-0.821,P<0.001）;两种颈椎曲度测量法弧弦距与C_2-7Cobb角成正相关（R=0.840,P<0.001）。③经多元线性回归获得a/M比值的预测方程,其F=8.959,R=0.434,P<0.001,其中椎间隙前高、年龄和颈椎曲是颈脊髓受压的影响因素。结论:a/M比值可作为临床评价脊髓受压程度的标准;通过颈椎X线片的颈椎间隙、颈椎曲度的变化对颈脊髓受压程度的预测有一定的应用价值。

Analysis of correlation between the cervical spinal cord compression and the change of cervical intervertebral disc space,curvature of cervical vertebrae

Objective:To discuss the correlation between the degree of cervical spinal cord compression and gender,age,height of intervertebral space and the abnormality curvature of cervical vertebrae. The multivariable linear regression was used to build the prediction model of cervical spinal cord compression. Methods:One hundred and twenty patients with cervical spondylosis were divided into 4 groups according to the degree of spinal cord compression. To measure the sagittal diameter of spinal cord（a） and medulla-pons junction（M） in MRI individually,and then calculate the ratio of a/M;according to the ratio to evaluate the degree of cervical spinal cord compression. In X-ray films to measure the height and angle of intervertebral space,curvature of cervical vertebrae (according to Borden’s method and double line method of C_2-7 Cobb angle to abtain data of curvature of cervical vertebrae). To performe linear regression and multiple linear regression to analyze the correlation above the data and build the prediction model of cervical spinal cord compression. Results:①With the exacerbation of cervical spinal cord compression,all measured data gradually decreased; there was significant difference in the anterior height and angle of intervertebral space,the ratio of a/M between any two groups（P<0.05）.②The ratio of a/M showed positive corrrelation with the anterior height of intervertebral space（R=0.296,P<0.001）and the curvature of cervical vertebrae（arc to chord distance,R=0.241,P<0.001）,but showed negative corrrelation with the proportion of cervical spinal cord compression（R=-0.821,P<0.001）; Borden’s method （arc to chord distance） showed positive correlation with the double line method of C_2-7 Cobb angle （R=0.840,P<0.001）. ③The predictive equation of the ratio of a/M by multiple linear regression was obtained,and the F=8.959,R=0.434,P<0.001,in which the age,the anterior height of intervertebral space and the curvature of cervical vertebrae were risk factors of cervical spinal cord compression. Conclusion:The ratio of a/M can be a standard to evaluate degree of cervical spinal cord compression;the changes of the height of intervertebral disc,curvature of cervical vertebrae in X-ray films maybe have values to predict the degree of cervical spinal cord compression.