| 摘要: |
| 目的 通过测量颈椎病患者椎间盘高度，提出颈椎间盘退变过程中椎间盘高度的3种状态。方法 选取2017年1月至5月于我院接受手术治疗的96例颈椎病患者，测量侧位X线片上C2～7椎间盘高度。根据Pfirrmann评分将患者分为3组：解剖高度组（Pfirrmann评分Ⅰ～Ⅱ级）、自然高度组（Pfirrmann评分Ⅲ级）和病理高度组（Pfirrmann评分Ⅳ～Ⅴ级），比较分析3组椎间盘高度的差异。结果 96例患者平均年龄为（53.4±19.6）岁，男性57例，女性39例；59例诊断为脊髓型颈椎病，25例为神经根型颈椎病，12例为混合型颈椎病。解剖高度组椎间盘平均高度为（7.7±1.2）mm，自然高度组为（7.1±0.9）mm，病理高度组为（5.9±1.0）mm，3组比较及两两比较差异均有统计学意义（P均<0.01）。C3～4、C4～5、C5～6、C6～7椎间盘解剖高度和自然高度、自然高度和病理高度的cut-off值（灵敏度，特异度）分别为7.45 mm（0.62，0.65）、6.95 mm（0.63，1.00），7.75 mm（0.49，0.85）、6.10 mm（0.89，0.43），7.75 mm（0.59，0.77）、6.95 mm（0.66，0.91）和7.85 mm（0.61，0.89）、5.95 mm（0.86，0.73）。结论 颈椎退变过程中，椎间盘高度有解剖高度、自然高度（退变高度）和病理高度3种状态。颈椎病前路手术时应关注术前椎间盘高度，撑开至自然高度为宜。 |
| 关键词: 颈椎间盘高度 轴性痛 脊髓牵拉 颈椎间盘退变 |
| DOI：10.16781/j.0258-879x.2018.06.0667 |
| 投稿时间：2017-11-30修订日期：2018-03-22 |
| 基金项目: |
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| X-ray measurement of anatomical, natural and pathological heights of cervical intervertebral disc and its clinical significance |
| WANG Shun-min,XU Xi-ming,YANG Yong,WANG Yuan,SUN Jing-chuan,MENG Ya-ke,GUO Yong-fei,YANG Hai-song,SHI Jian-gang* |
(Department of Spine Surgery(Ⅱ), Changzheng Hospital, Navy Medical University(Second Military Medical University), Shanghai 200003, China
*Corresponding author) |
| Abstract: |
| Objective To propose the three heights of intervertebral disc during cervical disc degeneration by measuring the cervical intervertebral disc heights in patients with cervical spondylosis. Methods Totally 96 patients with cervical spondylosis undergoing surgery in our hospital from Jan. 2017 to May 2017 were enrolled in this study, and their intervertebral disc heights of C2-7 were measured by the lateral X-ray. The patients were divided into 3 groups according to the Pfirrmann score:anatomical height group (Pfirrmann scoreⅠ-Ⅱ grade without height loss), natural height group (Pfirrmann score Ⅲ grade), and pathological height group (Pfirrmann score Ⅳ-Ⅴgrade with moderate and severe intervertebral height loss). Two-way ANOVA and LSD analysis were performed to compare the intervertebral disc heights between the three groups. Results The average age of 96 patients was (53.4±19.6) years old, with 57 males and 39 females. Fifty-nine cases were diagnosed with cervical spondylotic myelopathy, 25 with nerve root type cervical spondylosis, and 12 with mixed cervical spondylosis. The average intervertebral disc heights in the anatomic height, natural height and pathological height groups were (7.7±1.2) mm, (7.1±0.9) mm and (5.9±1.0) mm, respectively, and there were significant differences between the three groups (all P<0.01). The cut-off values (sensitivity, specificity) of the anatomical heights and natural heights, natural heights and pathological heights of C3-4, C4-5, C5-6 and C6-7 were 7.45 mm (0.62, 0.65) and 6.95 mm (0.63, 1.00), 7.75 mm (0.49, 0.85) and 6.10 mm (0.89, 0.43), 7.75 mm (0.59, 0.77) and 6.95 mm (0.66, 0.91), and 7.85 mm (0.61, 0.89) and 5.95 mm (0.86, 0.73), respectively. Conclusion During the process of degeneration, cervical disc height can be classified as anatomical height, natural height (degenerative height) and pathological height. We should pay attention to the intervertebral disc height before operation and suggest to restore natural disc height. |
| Key words: cervical disc height axial pain spinal cord stretch cervical disc degeneration |
