CAJ | 학술논문

目的探讨单节段脊髓型颈椎病患者颈椎X线片相关指标与椎间盘突出导致的颈脊髓压迫严重程度的相关性。方法回顾性分析2012年8月—2014年3月安徽医科大学第一附属医院脊柱外科诊治的60例单节段脊髓型颈椎病患者的临床资料,均为男性,年龄42~65岁,平均(54.8依9.3)岁。在颈椎MRI矢状位成像上按照颈脊髓受压的比例( E值)分为Ⅰ组、Ⅱ组及Ⅲ组。在颈椎MRI横断面成像上测量并计算颈髓横切面积( S1)与有效椎管横切面积( S0)的比值,以此判断椎间盘突出程度；在不同体位颈椎X线摄片上测量责任椎间隙的活动度值(B值)、椎间隙前缘高度( D值)、颈椎C2~7 Cobb角及椎间孔面积( M值)等相关指标。采用直线相关回归分析颈椎间盘突出程度与各观测指标之间的相关性。结果3组间S1/S0值、E值、B值、D值、C2~7 Cobb角和M值差异均有统计学意义(F值分别为44.187、112.789、7.232、3.778、3.232、15.813,P值均<0.05)。随着S1/S0值的增加,E值、B值、D值、C2~7 Cobb角和M值均逐渐减小,提示责任椎间隙E值、B值、D值、C2~7 Cobb角、M 值与 S1/S0值均呈负相关性( R 值分别为-0.821、-0.581、-0.378、-0.419、-0.576,P值均<0.05)。经多元线性回归分析,B 值、D 值、M 值是 S1/S0的3个独立影响因素, S1/S0值的预测方程为^Y=118.955-1.348X1-2.850X2-0.541X3(复相关系数R=0.742,决定系数R2=0.550,F=22.841,P<0.01),回归模型有统计学意义。结论不同体位颈椎X线摄片的相关指标B值、D值、M值是影响脊髓型颈椎病椎间盘退变突出程度的独立因素,对评估单节段脊髓型颈椎间盘突出的严重程度有一定的诊断价值；采用D值、B值及M值为3个自变量指标,可对椎间盘突出进行预测。
목적탐토단절단척수형경추병환자경추X선편상관지표여추간반돌출도치적경척수압박엄중정도적상관성。방법회고성분석2012년8월—2014년3월안휘의과대학제일부속의원척주외과진치적60례단절단척수형경추병환자적림상자료,균위남성,년령42~65세,평균(54.8의9.3)세。재경추MRI시상위성상상안조경척수수압적비례( E치)분위Ⅰ조、Ⅱ조급Ⅲ조。재경추MRI횡단면성상상측량병계산경수횡절면적( S1)여유효추관횡절면적( S0)적비치,이차판단추간반돌출정도；재불동체위경추X선섭편상측량책임추간극적활동도치(B치)、추간극전연고도( D치)、경추C2~7 Cobb각급추간공면적( M치)등상관지표。채용직선상관회귀분석경추간반돌출정도여각관측지표지간적상관성。결과3조간S1/S0치、E치、B치、D치、C2~7 Cobb각화M치차이균유통계학의의(F치분별위44.187、112.789、7.232、3.778、3.232、15.813,P치균<0.05)。수착S1/S0치적증가,E치、B치、D치、C2~7 Cobb각화M치균축점감소,제시책임추간극E치、B치、D치、C2~7 Cobb각、M 치여 S1/S0치균정부상관성( R 치분별위-0.821、-0.581、-0.378、-0.419、-0.576,P치균<0.05)。경다원선성회귀분석,B 치、D 치、M 치시 S1/S0적3개독립영향인소, S1/S0치적예측방정위^Y=118.955-1.348X1-2.850X2-0.541X3(복상관계수R=0.742,결정계수R2=0.550,F=22.841,P<0.01),회귀모형유통계학의의。결론불동체위경추X선섭편적상관지표B치、D치、M치시영향척수형경추병추간반퇴변돌출정도적독립인소,대평고단절단척수형경추간반돌출적엄중정도유일정적진단개치；채용D치、B치급M치위3개자변량지표,가대추간반돌출진행예측。
Objective To investigate the relationship of the related parameters of X-ray and the severity of cervical spinal cord compression caused by disc herniation in patients with single segment spondylotic myelopathy. Methods Clinical data of sixty paitents with single segment spondylotic myelopathy in the First Affiliated Hospital of Anhui Medical University from August 2012 to March 2014 were retrospectively analyzed. All the patients, aged from 42 to 65 (58. 4±9. 3), were male. According to the compression ratio ( E value) of cervical spinal cord in sagittal MRI images, all the patients were firstly divided into group Ⅰ, II and Ⅲ. The ratio of cervical spinal crosscutting area ( S1 ) to effective cervical canal crosscutting area ( S0 ) in cross-sectional imagings of cervical spine MRI was then calculated to reflect the degree of intervertebral disc herniation. Furthermore, the following indicators in cervical X-ray in different postures were measured for each case: the range of motion of the responsibility of intervertebral space ( B value) , the height of the anterior of intervertebral space ( D value) , Cobb angle of C2-7 , and the area of intervertebral foramen ( M value) . Linear correlation regression was used to study the relationship of the severity of cervical spinal cord compression and the above observation indexes. Results There were significant differences in the ratio of S1/S0 , E value, B value, D value, M value and Cobb angle of C2-7 among three groups (F values were 44. 187, 112. 789, 7. 232, 3. 778, 3. 232 and 15. 813, respectively. all P values<0. 05). E value, B value, D value, M value and Cobb angle of C2-7 decreased with the increase of the ratio of S1/S0 . These indicated that E value, B value, D value, M value and Cobb angle of C2-7 were negatively correlated with the ratio of S1/ S0 ( R values were-0. 821, -0. 581, -0. 378, -0. 419 and-0. 576, respectively, all P values<0. 05). The multiple linear regression results showed that B value, D value and M value were the three independent factors of the ratio of S1/S0 , and the prognostic equation of the ratio of S1/S0 was ^Y=118. 955 -1. 348X1 -2. 850X2 -0. 541X3 ( multiple correlation coefficient R=0. 742, decision coefficient R2 =0. 550, F=22. 841, P<0. 01). Conclusions The related indicators of B value, D value and M value in cervical vertebral X-ray of different positions are independent factors of intervertebral disc herniation in cervical spondylosis myelopathy, and have certain diagnostic effect for assessing the severity of single segmental intervertebral disc herniation in cervical spondylosis myelopathy. Accordind to these studies, the severity of cervical intervertebral disc herniation can be predicated by measuring the B value, D value and M value.