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目的:分析青少年Chiari畸形Ⅰ型(Chiari malformation typeⅠ,CMⅠ)合并脊髓空洞患者颈椎管矢状面锥度大小。方法:2007年10月~2013年10月在我科入院治疗且以胸椎侧凸为主首诊的青少年CMⅠ合并脊髓空洞患者共61例,男28例,女33例,年龄10~18岁,平均13.7±2.1岁,胸椎侧凸Cobb角42°~78°,平均51.5°±16.5°;以胸椎侧凸为主的AIS患者共75例,男35例,女40例,年龄11~18岁,平均14.8±1.8岁,胸椎侧凸Cobb角40°~69°,平均47.4°±15.3°。选取正常青少年志愿者60例作为正常对照组,男28例,女32例,年龄11~18岁,平均15.6±2.6岁。3组研究对象年龄与性别分布、CMⅠ组与AIS组胸椎侧凸Cobb角均无统计学差异(P>0.05)。在MR T2加权像正中矢状位扫描层面上测量颈椎管前后径,绘制散点图及趋势线,趋势线的斜率计为C1~C7椎管矢状面锥度。应用方差分析,比较3组研究对象颈椎管矢状面锥度的大小,并分析不同年龄分组(≤14岁与>14岁)和性别分组间颈椎管矢状面锥度的差异。结果:CMⅠ组、AIS组和正常对照组颈椎管平均矢状面锥度分别为-0.58±0.42mm/节段(-1.38~0.98mm/节段),-0.28±0.15mm/节段(-0.02~-0.70mm/节段)和-0.29±0.28mm/节段(-0.79~0.33mm/节段),CMⅠ组颈椎管矢状面锥度显著大于AIS组(P<0.05)和正常对照组(P<0.05),而AIS组与正常对照组比较无统计学差异(P>0.05)。3组颈椎管矢状面锥度在年龄、性别分组间均无统计学差异(P>0.05)。结论:与AIS患者和正常青少年相比,青少年CMⅠ合并脊髓空洞患者具有较大的颈椎管矢状面锥度,表明其颈椎管矢状面发育存在异常。
Objective: To analyze the sagittal taper of cervical spinal canal in Chiari malformation type Ⅰ (CM Ⅰ) patients with syringomyelia. Methods: From October 2007 to October 2013, 61 cases of CM Ⅰ complicated with syringomyelia were admitted to our hospital and were diagnosed mainly with thoracic scoliosis. There were 28 males and 33 females aged from 10 to 18 years old, With an average of 13.7 ± 2.1 years old. Cobb angle of thoracic scoliosis ranged from 42 ° to 78 ° with an average of 51.5 ° ± 16.5 °. A total of 75 AIS patients with thoracic scoliosis included 35 males and 40 females, aged 11-18 years , An average of 14.8 ± 1.8 years old, thoracic Cobb angle 40 ° ~ 69 °, an average of 47.4 ° ± 15.3 °. Sixty normal and adolescent volunteers were selected as normal control group, 28 males and 32 females, aged from 11 to 18 years, with an average of 15.6 ± 2.6 years. There was no significant difference in the Cobb angle of thoracic scoliosis between CM Ⅰ group and AIS group (P> 0.05). The anteroposterior diameter of the cervical canal was measured on the MR sagittal plane of the MR T2-weighted image. The scatter plot and the trend line were plotted. The slope of the trend line was calculated as the sagittal taper of the C1-C7 spinal canal. The variance analysis was used to compare the sagittal taper of the cervical spinal canal in the three groups. The sagittal taper of the cervical canal in different age groups (≤14 years old and> 14 years old) and gender groups were analyzed. Results: The mean sagittal taper of cervical canal in CM Ⅰ group, AIS group and normal control group were -0.58 ± 0.42mm / segment (-1.38 ~ 0.98mm / segment), -0.28 ± 0.15mm / segment ~ -0.70mm / segment) and -0.29 ± 0.28mm / segment (-0.79 ~ 0.33mm / segment). The sagittal taper of cervical spinal canal in CMⅠgroup was significantly higher than that in AIS group (P <0.05) and normal control group P <0.05), while there was no significant difference between AIS group and normal control group (P> 0.05). There was no significant difference in sagittal taper of cervical canal between the three groups (P> 0.05). Conclusions: Compared with AIS patients and normal adolescents, the adolescent patients with CM Ⅰ complicated with syringomyelia have larger cervical canal sagittal taper, which indicates that the cervical canal sagittal plane is abnormal.