颈椎椎管容积动态CT测量及其临床意义.docVIP

颈椎椎管容积动态CT测量及其临床意义 　【摘要】 通过三种体位下的动态CT测量，观察正常人和脊髓型颈椎病（CSM）患者的颈椎椎管占位率的动态变化，并探讨其临床意义。［方法］对10例正常人和20例CSM患者分别行中立位、过屈位和过伸位螺旋CT扫描(C4～6)，将数据传至工作站，进行容积再现(volume Rendering,VR)等后处理成像，测量每一截面骨性椎管和纤维性椎管的面积及椎管椎体的矢状径线，利用MATLAB求出三种体位下颈椎的椎管占位率，经统计学处理后分析其动态变化。［结果］在中立位下，正常人和CSM患者的颈椎椎管占位率差异有显著性意义(Plt;001)，CSMgt;正常人。对于CSM患者，其中立位下颈椎管率与JOA评分不相关，Pearson相关系数为0183(Pgt;005)；继发性椎管矢状径、有效椎管率和椎管占位率与JOA评分密切相关，Pearson相关系数分别为0445(Plt;005)，0496(Plt;005)，-0611(Plt;001)。在不同体位下，正常人和CSM患者的颈椎椎管占位率的动态变化相一致，均为：过伸位gt;中立位gt;过屈位，且差异有显著性意义(Plt;001)。［结论］(1)颈椎管占位率可以客观反映颈椎屈伸运动中颈脊髓受压程度的动态变化，对预测CSM的发病、判断脊髓的受压程度、合理选择手术方式均具有重要意义。(2)过伸位时椎管占位率增大，是过伸性颈椎损伤发生的机制所在；过屈位时颈椎管占位率减小，可能是颈椎生理曲度变直或反曲的机体代偿机制之一。 【关键词】 颈椎 椎管容积 占位率 螺旋CT 测量 Abstract ［Objective］To measure cervical spinal canal volume under dynamic CT，and realize the dynamic change of the canal volume occupying ratio by herniated disc and tissue in three positions：hyperflexion，neutral and hyperextension，in normal adults and cervical spondylotic myelopathy(CSM) patients，and then probe its clinical significance［Method］ Ten cases of normal and 20 cases of CSM were scanned in hyperflexion,neutral and hyperextension positions under spiral CT(C4-C6)All the information was transferred to GE Advantage Workstation 42 for assessmentBy using Volume Rendering(VR),the areas of both bony canal and fibrous canal in every chosen cross-sections and the sagittal diameters of cervical canal and cervical vertebra body were medsuredThe cervical spinal canal volume occupying ratio were cafculafed under the three positions using MATLAB，and statisticly analyzed the dynamic change［Result］ There was significant difference of the cervical spinal canal volume occupying ratio in neural position between normal and CSM patients(Plt;001)For those CSM patients，the cervical spinal canal ratio in neural position was in poor correlation with JOA score，its pearson coefficient correlation was 0183(Pgt;005)The secondary sagittal diameter of cervical spinal canal，the effective cervical spi