颈椎侧位X线片测量评估退行性颈椎管狭窄

目的应用新的X线片测量方法测量颈椎管率及有效颈椎管率,确定诊断退行性颈椎管狭窄的敏感指标。方法取100名不同年龄段的无症状的成年人颈椎侧位X线片,测量颈椎管矢状径(a)、椎体中矢径(b)、退变椎体矢状径(c),计算颈椎管率(a/b)、有效颈椎管率犤(a b-c)/c犦,分性别、年龄段进行统计分析。结果(1)不同年龄组的颈椎管率差异无统计学意义。(2)不同年龄组的有效颈椎管率其差异在C3、C7节段无统计学意义,而在C4～C6节段有非常显著性(P<0.01)。(3)男女之间的颈椎管矢状径差异无显著性,而椎体中矢径及退变椎体矢状径差异有显著性,颈椎管率和有效颈椎管率男性小于女性(P<0.01)。结论(1)颈椎管率是诊断发育性颈椎管狭窄的指标,有效颈椎管率是诊断退行性颈椎管狭窄的指标。(2)有效颈椎管率低于0.6时,应考虑退行性颈椎管狭窄。(3)40岁以上患者在X线侧位片上除外发育性颈椎管狭窄后,还应考虑是否存在退行性颈椎管狭窄。

Radiographic measurement for evaluation of degenerative cervical spinal canal stenosis

Objective To determine sensitive indices for defining degenerative cervical spinal canal stenosis(DCSCS) with a new radiograghic measurement method. Methods One hundred normal lateral radiographs of the cervical spine were divided into two groups according to ages. The following indices were measured or calculated: sagittal diameter of spinal canal(a), sagittal diameter of cervical body(b), sagittal diameter of edge or degenerative cervical body(c), cervical spinal canal ratio[(a/b),CSCR] and effective cervical spinal canal ratio [(a b-c)/c,ECSCR]. The comparisons of these indices between two groups were performed to select the most sensitive index for clinical reference. Results There was no significant difference between the two age groups in terms of a, b and a/b. The comparison of c and (a b-c)/c between two age groups showed significant difference at the level of C4,C5 and C6 (P< 0.01), but no difference at C3 and C7. The comparison of ECSCR revealed significant statistical difference (P< 0.01). Conclusion ECSCR is a sensitive index in reflecting degenerative cervical spinal canal stenosis. Degenerative cervical spinal canal stenosis should be considered when the value of ECSCR is less than 0.6. For aging patients with cervical problems, not only developmental cervical stenosis should be evaluated, but also degenerative stenosis is supposed to be excluded by ECSCR.