Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China.
Biomed Res Int. 2019 Jan 13;2019:9830243. doi: 10.1155/2019/9830243. eCollection 2019.
Because Hirayama disease is stereotyped as a self-limited disease in the absence of a definite pathology, we investigated the potential relationship between snake-eyes appearance (SEA) and Hirayama disease to bring a new perspective in the pathological process of Hirayama disease based on relevant radiological and clinical evidence.
A total of 30 cases observed SEA were selected from 293 patients with Hirayama disease to constitute the SEA group, and an equal number of cases were randomly selected from the remaining patients to form the non-SEA group. Cervical magnetic resonance imaging (MRI) was performed and subsequently used to measure the anteroposterior diameter and anterior shifting of the spinal cord. Additionally, clinical data, such as age, sex, duration of symptoms, symptoms, and signs, were collected and analyzed.
Of 293 patients, 10.6% appeared with the SEA, which was mainly multisegmental (86.7%), particularly at the C5-6 segment (73.3%), and intense with a well-defined border (70.0%). The SEA group was an older population (p < 0.0001) with a longer duration (p < 0.0001) and a higher incidence of Hoffmann signs and knee hyperreflexia (p < 0.0001, p = 0.0038, respectively). The degree of spinal cord atrophy demonstrated a close association with the SEA, as it was significantly worse in the SEA group and SEA segment (p = 0.0008, p < 0.0001, respectively). The degree of spinal cord atrophy was positively related to both age and duration (p = 0.0095, p = 0.0176, respectively).
Confirmed as an irreversible lesion and an indication of poor prognosis, SEA appears during the late stage of Hirayama disease and is closely related to pyramidal signs and spinal cord atrophy.
由于平山病在缺乏明确病理的情况下被认为是一种自限性疾病，我们研究了蛇眼征（SEA）与平山病之间的潜在关系，以期根据相关的影像学和临床证据，为平山病的病理过程带来新的视角。
从 293 例平山病患者中选择 30 例观察到 SEA 的患者构成 SEA 组，并从其余患者中随机选择相同数量的病例构成非-SEA 组。对所有患者均进行颈椎磁共振成像（MRI）检查，测量脊髓的前后径和前移。同时收集并分析患者的年龄、性别、症状持续时间、症状和体征等临床资料。
293 例患者中，10.6%出现 SEA，主要为多节段性（86.7%），特别是在 C5-6 节段（73.3%），SEA 边界清晰且明显（70.0%）。SEA 组患者年龄较大（p＜0.0001），症状持续时间较长（p＜0.0001），Hoffmann 征和膝反射亢进的发生率较高（p＜0.0001，p=0.0038）。SEA 组的脊髓萎缩程度与 SEA 密切相关，SEA 组和 SEA 节段的脊髓萎缩程度明显更严重（p=0.0008，p＜0.0001）。脊髓萎缩程度与年龄和症状持续时间呈正相关（p=0.0095，p=0.0176）。
SEA 被确认为不可逆病变和预后不良的标志，出现在平山病的晚期，与锥体束征和脊髓萎缩密切相关。
