伴颈5/6椎间孔狭窄神经根型颈椎病影像学特点及临床意义

目的 观测伴C5/C6椎间孔狭窄神经根型颈椎病患者的颈椎间孔形态及三维空间下的各相关径值，分析并探讨其临床意义。方法 随机选取492例伴C5/C6椎间孔狭窄，在上海长征医院于2014年9月至2019年7月期间行手术治疗的神经根型颈椎病患者，行颈椎正侧位X线、颈椎CT、颈椎磁共振等检查，数字骨科系统重建后观测椎间孔形态并测量最佳投射角度下的纵径、上前后径、下前后径、横截面积、椎间隙高度等径值并对其进行统计学处理，比较病例组与正常成人组C5/C6椎间孔之间、病例组病变椎间孔与对侧椎间孔以及病例组中男女患者之间的差异。结果 病例组C5/C6椎间孔形态因骨赘增生等，以纺锤形、不规则形为主，病例组C5/C6椎间孔横径均值、纵径、横截面积、椎间隙平均高度分别为（5.81±1.40）mm、（10.45±1.70）mm、（50.02±15.46）mm2、（4.99±0.89）mm，均比正常成人组减小，且差异有统计学意义（P<0.01）；男女间比较差异无统计学意义（P>0.05）。结论 伴C5/C6椎间孔狭窄神经根型颈椎病患者的颈椎间孔的形态发生改变，导致椎间孔的横径均值及横截面积值均明显减小；椎间孔的横径在诊断颈椎间孔狭窄方面敏感性及特异性高；术中减压时应更加注重椎间孔横径的有效扩大，以提高手术效果。

Measurement and Clinical Significance of C5/C6 Cervical Intervertebral Foramen in Patients with Cervical Spondylotic Radiculopathy Caused by Intervertebral Foramen Stenosis

Objective To observe the morphology of cervical intervertebral foramen and the related diameters in three-dimensional space in patients with cervical spondylotic cervical spondylosis with C5/C6 intervertebral foramen stenosis, and to analyze and explore its clinical significance. Methods A total of 492 patients with cervical spondylotic radiculopathy with C5/C6 intervertebral foramen stenosis were examined by anterior and lateral cervical vertebra, cervical CT and cervical magnetic resonance. After digital orthopaedic system reconstruction, the shape of intervertebral foramen was observed and the longitudinal diameter, superior anterior and posterior diameter, inferior anterior and posterior diameter, cross-sectional area and height of intervertebral space were measured and statistically analyzed. The differences of C5/C6 intervertebral foramen between case group and normal adult group, between diseased intervertebral foramen and contralateral intervertebral foramen in case group, and between male and female patients in case group were compared. Results The shape of intervertebral foramen C5/C6 in case group was mainly spindle and irregular due to osteophyte hyperplasia. the average transverse diameter, longitudinal diameter, cross sectional area and average height of intervertebral space in case group were 5.81 ±1.40mm, 10.45 ±1.70mm, 50.02 ±15.46mm2 and 4.99 ±0.89mm, respectively, while those in normal adults were 7.60 ±1.37mm, 11.66 ±1.95mm, 72.80 ±22.48mm2 and 5.78 ±0.95mm, respectively. The number in the case group was lower than that in the normal group, and the difference was statistically significant (P<0.05), but there was no significant difference between men and women (P>0.05). Conclusion The morphological changes of cervical intervertebral foramen in patients with cervical spondylotic intervertebral foramen stenosis lead to a significant decrease in the mean transverse diameter and cross-sectional area of cervical intervertebral foramen. The transverse diameter of intervertebral foramen is more sensitive and specific in the diagnosis of cervical intervertebral foramen stenosis. We boldly suggest that C5/C6 cervical intervertebral foramen bony stenosis can be diagnosed if the mean transverse diameter of C5/C6 intervertebral foramen is less than 5.34mm. During intraoperative decompression, more attention should be paid to the effective enlargement of the transverse diameter of the intervertebral foramen, and the treatment of the anterior and posterior wall of the intervertebral foramen and the soft tissue inside and outside the intervertebral foramen should not be ignored, and the intervertebral space should be properly raised and the cross-sectional area of the intervertebral foramen should be increased properly so as to comprehensively improve the effect of the operation and improve the prognosis of the patients.