CAJ | 학술논문

目的研究青少年特发性脊柱侧凸(adolescent idiopathic seoliosis,AIS)的MRI特征性变化,探讨AIS的MRI特征性变化与侧凸严重度的相关性.方法应用三维莺建MRI技术对90例青少年(49例AIS,41名健康青少年)进行全脊髓脊柱和后脑MR检查.测量颈椎和胸椎各节段的脊髓最大前后径(AP)、最大横向直径(TS)和凸凹侧脊髓旁间隙(LCS)、小脑扁桃体与枕骨大孔基线的距离、齿突与枕骨大孔基线的距离、颈髓中轴线与延髓中轴线夹角(α)、枕骨大孔基线与延髓中轴线夹角(β)、脊髓面积、椎管面积、脊髓椎管面积比,测量脊髓全长、脊柱全长、脊髓脊柱全长比.结果与健康对照组相比,AIS患者的AP、TS、AP/TS 和LCS比值明显增加,小脑扁桃体位置相对枕骨大孔明显下移,脊髓圆锥位置相对上移,β角减小,脊髓椎管面积比增大(P＜0.01);AIS组与对照组相比,全脊髓或全脊柱长度差异无统计学意义,但脊髓脊柱全长比明显减小(P＜0.01),与Cobb角无明显相关性.AP、AP/TS和LCS比值与Cobb角明显正相关(P＜0.05).结论 AIS患者在脊髓和脊柱的横断面上存在显著性形态学异常,部分与Cobb角有明显正相关;脊髓和脊柱纵轴上存在明显的脊髓牵拉受限,提示可能存在神经系统和骨骼系统的生长不平衡,这些可能与AIS的发病机制有关.
목적 연구청소년특발성척주측철(adolescent idiopathic seoliosis,AIS)적MRI특정성변화,탐토AIS적MRI특정성변화여측철엄중도적상관성.방법 응용삼유앵건MRI기술대90례청소년(49례AIS,41명건강청소년)진행전척수척주화후뇌MR검사.측량경추화흉추각절단적척수최대전후경(AP)、최대횡향직경(TS)화철요측척수방간극(LCS)、소뇌편도체여침골대공기선적거리、치돌여침골대공기선적거리、경수중축선여연수중축선협각(α)、침골대공기선여연수중축선협각(β)、척수면적、추관면적、척수추관면적비,측량척수전장、척주전장、척수척주전장비.결과 여건강대조조상비,AIS환자적AP、TS、AP/TS 화LCS비치명현증가,소뇌편도체위치상대침골대공명현하이,척수원추위치상대상이,β각감소,척수추관면적비증대(P＜0.01);AIS조여대조조상비,전척수혹전척주장도차이무통계학의의,단척수척주전장비명현감소(P＜0.01),여Cobb각무명현상관성.AP、AP/TS화LCS비치여Cobb각명현정상관(P＜0.05).결론 AIS환자재척수화척주적횡단면상존재현저성형태학이상,부분여Cobb각유명현정상관;척수화척주종축상존재명현적척수견랍수한,제시가능존재신경계통화골격계통적생장불평형,저사가능여AIS적발병궤제유관.
Objective To determine the longitudinal and cross-sectional morphology of the spinal column and cord in adolescent idiopathic scoliosis(AIS)versus healthy controls and their correlation with Cobb angle.Methods A prospective study of three-dimensional reconstruction MR examination of the whole spine and column and hindbrain was performed in 90 adolescents including 49 patients with AIS and41 healthy adolescents.The ratio of anteroposterior(AP)and transverse(TS)diameter of the cord,the con-cave and convex lateral cord space(LCS)were measured at each cervical and thoracic level.The data col-lected from three-dimensional MRI also included the cerebellar tonsillar level related to the basion-opsithion(BO)line,odontoid process level related to the BO line,location of conus medullaris,the angle between axis of cervical cord and medulla oblongata(α),the angle between axis of BO line and medulla oblongata(β),the cord length,the vertebral length,the cord/vertebral length ratio,the cord area,the vertebral canal area,the cord/vertebral canal area ratio.Results AP,TS,AP/TS and LCS ratio increased in patients with AIS.The position of cerebellar tonsillar had descended; while the conus medullaris had ascended obivously.β angle decreased and cord/vertebral area ratio increased when compared with normal controls(P＜0.01).AP,AP/TS and LCS ratio were correlated significantly with Cobb angle(r＞0.19,P＜0.05).Conclusion Our study re-vealed significantly abnormal cross-sectional morphology of spinal cord.Some changes are significantly rele-vant with Cobb angle.As for the longitudinal axis of spinal cord,there is tethering of the spine cord suggest-ing the presence of disproportional growth between the neural and skeletal system,which may explain patho-genesis of AIS.