CAJ | 학술논문

目的本研究旨在明确青少年特发性脊柱侧凸(AIS)患者颅颈交界处是否亦存在脑脊液阻塞及其与小脑扁桃体位置、枕骨大孑L大小及体表皮层诱发电位异常的相关性.方法对30例AIS和30例年龄、性别匹配的正常对照组进行常规和相位对比法核磁共振检查.在枕骨大孑L处蛛网膜下腹侧和背侧分别选择4个兴趣Ⅸ测量两组的脑脊液流动峰值速度.在正中矢状面上测量小脑扁桃体相对枕骨大孔连线的位置,枕骨大孔前后径、横径以及面积.将测量参数与体表皮层诱发电位进行相关性分析.结果 AIS患者枕骨大孔处脑脊液流动速度峰值与正常对照组差异无统计学意义.尽管AIS患者中有50％的小脑扁桃体低于枕骨大孔连线1 mm且位置明显低于正常对照组,其枕骨大孔的前后径及面积明显大于正常对照组,小脑扁桃体位置和枕骨大孔面积呈明显负相关.体表皮层诱发电位止常和异常的AIS患者脑脊液流速以及枕骨大孔形态均无明显差异.结论尽管A1S患者存在低位小脑扁桃体,但其枕骨大孔处脑脊液流动并无明显阻塞,这可能是山于小脑扁桃体位置越低者其枕骨大孔越大而产生的中和代偿结果.AIS患者的体表皮层诱发电位异常亦与其枕骨大孔处的脑脊液流动无相关性.
목적 본연구지재명학청소년특발성척주측철(AIS)환자로경교계처시부역존재뇌척액조새급기여소뇌편도체위치、침골대혈L대소급체표피층유발전위이상적상관성.방법 대30례AIS화30례년령、성별필배적정상대조조진행상규화상위대비법핵자공진검사.재침골대혈L처주망막하복측화배측분별선택4개흥취Ⅸ측량량조적뇌척액류동봉치속도.재정중시상면상측량소뇌편도체상대침골대공련선적위치,침골대공전후경、횡경이급면적.장측량삼수여체표피층유발전위진행상관성분석.결과 AIS환자침골대공처뇌척액류동속도봉치여정상대조조차이무통계학의의.진관AIS환자중유50％적소뇌편도체저우침골대공련선1 mm차위치명현저우정상대조조,기침골대공적전후경급면적명현대우정상대조조,소뇌편도체위치화침골대공면적정명현부상관.체표피층유발전위지상화이상적AIS환자뇌척액류속이급침골대공형태균무명현차이.결론 진관A1S환자존재저위소뇌편도체,단기침골대공처뇌척액류동병무명현조새,저가능시산우소뇌편도체위치월저자기침골대공월대이산생적중화대상결과.AIS환자적체표피층유발전위이상역여기침골대공처적뇌척액류동무상관성.
Objective To investigate whether disturbed cerebrospinal fluid(CSF) flow at the craniocervical iunction is a feature of Adolescent Idiopathic Scoliosis (AIS)patients with marked curve and whether the disturbance is correlated with the position of cerebellar tonsils.size of foramen magnum and the abnormality of somatosensroy coatical evoked potential (SSEP).Methods The study involved 30 A1S,aged 11 to 19 years old(mean age 15),and 30 normal children with age and sex matched controls.Peak velocity of CSF flow was measured in foat regions of interest (ROIs) evenly placed in both anterior and posterior subarachnoid space.The cerebellar tonsillar level related to a referenee line connecting the basion and opsithion (BO line),anteroposterior(AP),transverse(TS)diameter and area of foramen magnum were measured.The bilateral posterior tibial nerve somatosensory evoked potentials (PTN-SSEP) was conducted,and the conical responses were recorded over the contralateral sensory"foot area"on the midline of the scalp.Resuits There was no significant difierence in the amplitude of peak CSF velocities in AIS patients.Though 50% AIS subjeets had cerebellar tonsillar tip positioned 1 mm below the BO line and the cerebellar tonsillar level in AIS patients was significantly lower than normal children,the area and AP diameter of foramen magnum in contrary were significantly larger in AIS group.Significant negative correlation was found between eere bellar tonsillar level and area of foramen magnum(P<0.05).The peak CSF and area of foramen magnum however showed no significant difference between AIS with and without abnormal SSEP.Conclusion There is no evidence of obstructed CSF flow at foramen magnum in AIS subjects despite presence of low-lying eerebellar tonsils.Crowding of posterior subarachnoid space is not a feature of AIS patients.On contrary,they have a relatively capacious foramen magnum.More lowlying cerebellar tonsils are associated with larger foramen magnum.Abnormal SSEP in AIS patients correlates with the CSF flow through foramen magnum.