【作者】 莫文； 许金海； 叶洁； 万宏波； 童正一； 徐华； 马俊明；

【Author】 MO Wen XU Jin-hai YE Jie WAN Hong-bo TONG Zheng-yi XU Hua MA-Junming (Department of Orthopedics and Traumatology,the Affiliated Longhua Hospital of Shanghai University of Traditional Chinese Medicine,Shanghai 200032 China)

【机构】 上海中医药大学附属龙华医院骨伤科；

【摘要】 目的探讨颈脊髓受压程度与性别、年龄、椎间隙及颈椎曲度变化的相关性,应用多元线性回归方法建立预测颈椎病患者颈脊髓受压程度的模型。方法选取颈椎矢状位MRI T2WI成像显示有椎间盘突出或脊髓受压者120例,按照脊髓受压程度分为4组,,在颈椎MRI成像上测量颈脊髓受压比例,椎间盘后凸顶点脊髓矢状径（a）、延髓与桥脑交界处矢状径（M）,计算a/M值来评估颈脊髓受压程度;在颈椎X线侧位片上测量相应节段椎间隙前后柱高度、椎间隙夹角以及颈椎曲度(Borden’s弧弦距、C_2-7Cobb角双线法);采用线性回归和多元线性回归分析上述各测量值之间的相关性,建立预测颈椎病患者颈脊髓受压程度的模型。结果①各测量值随着颈脊髓受压加重而逐渐减小,椎间隙前高、椎间隙角度、a/M比值四组间两两比较差异均有统计学意义（P<0.05）。②a/M比值与椎间隙前高呈正相关（R=0.296,P<0.001）;a/M比值与弧弦距呈正相关（R=0.241,P<0.001）;a/M比值与颈脊髓受压比例呈负相关（R=-0.821,P<0.001）;两种颈椎曲度测量法弧弦距与与C2-7Cobb角成正相关（R=0.840,P<0.001）。③经多元线性回归获得a/M比值的预测方程,其F=11.307,R=0.434,P<0.001,其中椎间隙前高、年龄和颈椎曲度（弧弦距）是颈脊髓受压的影响因素。结论a/M比值可作为临床评价脊髓受压程度的标准;通过颈椎X线片的颈椎间隙、颈椎曲度的变化对颈脊髓受压程度的预测有一定的应用价值。更多还原

【Abstract】 Objective To discuss the correlation between the degree of cervical spinal cord compression and gender、age、height of intervertebral space and the abnormality curvature of cervical spine,Using the Multivariable Linear regression to build the prediction model of cervical spinal cord compression.Methods: According to the degree of spinal cord compression,the MRI of 120 cases showed cervical disc herniation or spinal cord compression were divided into 4 groups.the sagittal diameter of spinal cord（a） and medulla-pons junction（M） were measured in MRI individually, calculated a/M ratio.In the X-ray films,the height of intervertebral space、angle and the curvature of cervical spine(Borden’s、C_2-7Cobb angle);Linear regression and multiple linear regression were performed to analyze the correlation among the datas mentioned above;Build the prediction model of cervical spinal cord compression. Results①The study showed that measured value decreases as the cervical spinal cord compression gradually increased,the anterior height of intervertebral space、angle and the a/M ratio of any two among the four groups were statistically significant differences（P<0.05）.②the a/M ratio showed positive relation with the anterior height of intervertebral space（R=0.296,P<0.001） and the curvature of cervical spine（arc chord length R=0.241,P<0.001）,but showed negative relation with the proportion of cervical spinal cord compression; Borden’s arc chord length showed positiverelation with the C_2-7Cobb angle（R = 0.840,P<0.001）.③By multiple linear regression,obtain the a / M ratio prediction equation,the F = 11.307,R = 0.434,P<0.001,which the age、the anterior height of intervertebral space and the curvature of cervical spine are risk factors of cervical spinal cord compression.Conclusion Thea/M ratio can be used to evaluate cervical spinal cord compression;By observing the changes of the intervertebral height and cervical curvature in X-ray films,the degree of cervical spinal cord compression can be predicted.更多还原