健康成人与颈5/6单节段脊髓型颈椎病患者颈椎MRI矢状面形态的比较

目的 探讨健康成人和C_5/6单节段脊髓型颈椎病（DCM）患者颈椎MRI矢状面形态的差异及与DCM的相关性。方法 回顾性研究。纳入2021年1—11月徐州医科大学附属医院脊柱外科门诊143例C_5/6单节段DCM患者（DCM组）及144例健康体检成人（对照组）的MRI影像资料。其中,DCM组男72例、女71例,年龄30~70（56.7±11.0）岁。对照组男72例、女72例,年龄30~70（55.8±9.4）岁。在颈椎MRI矢状面测量C₂斜率（C₂S）、颈前凸角（CL）、C_2~7矢状位轴向距离（cSVA）、T₁倾斜角（T₁S）、颈倾斜角（NT）、胸廓入口角（TIA）、脊柱-颅角（SCA）、颈椎倾斜（CeT）和颅倾斜（CrT）。分别在对照组、DCM组内对比不同性别间及两组间各项影像学参数的差异;在DCM组观察各影像学参数与单节段DCM发病的相关性。结果 对照组中,女性C₂S（11.25°±6.51°）大于男性（7.63°±7.82°）,CL（8.12°±8.45°）、T₁S（20.89°±6.50°）、TIA（71.72°±11.88°）、SCA（86.44°±8.54°）、CeT（16.20°±6.59°）均低于男性（14.69°±9.77°、23.27°±7.65°、75.50°±10.92°、95.89°±10.56°、19.23°±8.34°）,差异均有统计学意义（P值均<0.05）;cSVA、NT、CrT在不同性别间比较,差异均无统计学意义（P值均>0.05）。DCM组中,女性SCA（88.19°±11.78°）、CeT（15.11°±8.46°）低于男性（95.88°±11.84°、18.10°±9.21°）,而CrT（5.09°±4.22°）高于男性（3.82°±3.20°）,差异有统计学意义（P值均<0.05）;其他观察指标在不同性别间差异均无统计学意义（P值均>0.05）。对照组与DCM组：女性间比较,对照组NT（50.83°±12.66°）、TIA（71.72°±11.88°）均低于DCM组（55.81°±13.15°、76.02°±13.45°）,差异均有统计学意义（P值均<0.05）;男性间比较,对照组CL（14.68°±9.67°）高于DCM组（10.37°±13.78°）,NT（52.24°±8.89°）、TIA（75.50°±10.92°）低于DCM组（57.33°±11.18°、79.27°±9.40°）,差异均有统计学意义（P值均<0.05）。男性、女性C_5/6单节段DCM发病均与CL和NT相关（DCM女性组r=-0.26、0.28,DCM男性组r=-0.22、0.25,P值均<0.05）。结论 健康成人发展至C_5/6单节段DCM的过程中均与颈椎前凸的丢失相关,男性颈椎MRI矢状面形态的变化较女性更大。DCM患者不同性别间颈椎MRI矢状面形态的差异主要在于头颅重心位置不同和颈椎前移、前凸的程度不同。

Analysis of cervical sagittal alignments in MRIs between normal adults and patients with C5/6 single-level degenerative cervical myelopathy

Objective This study aimed to compare the differences and correlation of cervical sagittal alignment between healthy adults and patients with C_5/6 single-level degenerative cervical myelopathy (DCM) based on gender. Methods In this retrospective study, 143 patients with C_5/6 single-level DCM (DCM group) and 144 normal adults (control group) in the spinal surgery department of the Affiliated Hospital of Xuzhou Medical University from January to November 2021 were included. In the DCM group, 72 were males and 71 were females, aged between 30 and 70 (56.7±11.0) years. In the control group, 72 were males and 72 were females, aged between 30 and 70 (55.8±9.4) years. The following parameters were measured and recorded on sagittal MRI of the cervical spine: C₂ slope (C₂S), cervical lordosis (CL), C_2-7 sagittal vertical axis (cSVA), T₁ slope (T₁S), neck tilt (NT), thoracic inlet angle (TIA), spinocranial angle (SCA), cervical tilt (CeT), cranial tilt (CrT), and range of compressed spinal cord of patients with DCM. The differences in imaging parameters between males and females were analyzed in both groups, and the parameters of both genders were separately compared between the two groups. The correlation between spinal cord compression range and all imaging parameters was compared in male and female DCM group. Results In the control group, C₂S was higher in females (11.25°±6.51°) than in males (7.63°±7.82°), whereas CL(8.12°±8.45°), T₁S(20.89°±6.50°), TIA(71.72°±11.88°), SCA(86.44°±8.54°) and CeT(16.20°±6.59°) were all lower in females than in males (14.69°±9.77°, 23.27°±7.65°, 75.50°±10.92°, 95.89°±10.56°, and 19.23°±8.34°), and the difference was statistically significant (all P values <0.05). No significant difference was found in the cSVA, NT, and CrT between males and females (all P values >0.05). In the DCM group, SCA (88.19°±11.78°) and CeT (15.11°±8.46°) were lower in females than in males (95.88°±11.84° and 18.10°±9.21°), while the CrT (5.09°±4.22°) in females was higher than that in males (3.82°±3.20°), and the difference was statistically significant (all P values <0.05). Other imaging parameters showed no significant difference between the two genders (all P values <0.05). In females, the NT (50.83°±12.66°) and TIA(71.72°±11.88°) in the control group were lower than those in the DCM group (55.81°±13.15° and 76.02°±13.45°), and the difference was statistically significant (all P values <0.05). In males, the CL in the control group (14.68°±9.67°) was higher than that in the DCM group (10.37°±13.78°), while the NT and TIA in the control group (52.24°±8.89°, 75.50°±10.92°) was lower than that in the DCM group (57.33°±11.18°, 79.27°±9.40°), and the difference was statistically significant (all P values <0.05). The C_5/6 single-level DCM attack was correlated with CL and NT, and no significant difference was observed between females and males (r=-0.26, 0.28 in female DCM group, r=-0.22, 0.25 in male DCM group; all P values <0.05). Conclusions Loss of CL is associated with single-level DCM attack, and cervical spine morphology changes more significantly in the cervical spine degeneration towards DCM in healthy males than in females. The difference in MRI sagittal cervical morphology between the two genders in patients with DCM is mainly due to the differences in the position of the head barycenter, the degree of cervical lordosis and cervical prolapse.