枕颈融合术后Takami枕颈角与下颈椎曲度的相关性分析

The correlation between the occipitocervical angle of Takami and the curvature of lower cervical in patients after occipitocervical fusion

中文关键词:  颅底凹陷症  Takami枕颈角  C2-C7 Cobb角  下颈椎曲度  枕颈融合

英文关键词:Basilar invagination  Takami′s occipitocervical angle  C2-C7 Cobb angle  Subaxial cervical alignment  Occiptocervical fusion

中文摘要:

  【摘要】 目的：分析枕颈融合术后Takami枕颈角（Takami′s occipitocervical angle，TOCA）与下颈椎曲度的相关性分析，探讨术中枕颈固定合适的TOCA范围。方法：收集50例无颈部畸形、颈椎退变、颈部外伤史及手术史的成人（对照组）颈椎侧位X线片，测量TOCA及C2-C7 Cobb角。回顾性分析2010年1月～2016年12月于我院行后路枕颈融合手术并成功获得随访的17例颅底凹陷症（basilar invagination，BI）患者（BI组），在颈椎侧位X线片上分别测量术前、术后即刻和末次随访时TOCA及C2-C7 Cobb角，并以术后即刻TOCA为依据，参考正常组TOCA大小，将患者分为A、B、C三组（A组TOCA＜83°；B组TOCA为83°～89°；C组TOCA＞89°），收集A、B、C三组中术前、术后即刻及末次随访时的TOCA与C2-C7 Cobb角大小，以及正常组中TOCA与C2-C7 Cobb角大小，进行t检验及Pearson相关性分析。结果：对照组TOCA平均为86.2°±2.7°，C2-C7 Cobb角平均为17.4°±3.9°；对照组及BI组术前、末次随访时TOCA与C2-C7 Cobb角均呈正相关（P＜0.05）。A组中C2-C7 Cobb角术前与末次随访相比差异无统计学意义（P=0.088），但A组中C2-C7 Cobb角均值由术前15.4°±3.5°减至末次随访时11.7°±2.6°；B组中术前C2-C7 Cobb角（20.0°±4.5°）与末次随访时（21.8°±4.7°）相比无统计学差异（P＞0.05）；C组中术前C2-C7 Cobb角（21.6°±2.3°）与末次随访时（30.0°±4.3°）相比有统计学差异（P＜0.05）。结论：颅底凹陷症患者行枕颈融合术中TOCA固定在83°～89°能够减少对下颈椎曲度的影响。

英文摘要:

  【Abstract】 Objectives: By analyzing the correlation between Takami′s occipitocervical angle(TOCA) and lower cervical curvature after occipitocervical fusion and comparing with the normal group, the optimal TOCA angle of occipitocervical fixed is determined. Methods: Lateral cervical radiographs of 50 adults(control group) without cervical deformity, cervical degeneration, cervical trauma and surgery were collected, and TOCA and C2-C7 Cobb angle were measured respectively to statistically analyzed. Retrospective analysis of 17 patients with basilar invagination(BI group) who underwent posterior occipitocervical fusion surgery in our hospital from January 2010 to December 2016 and were followed up successfully, TOCA and C2-C7 Cobb angles were measured preoperative, immediate postoperative and at final follow-up on lateral cervical radiographs. Based on the TOCA of immediate postoperative and refer to the normal TOCA, patients were divided into group A, B and C(group A, TOCA<83°; group B, TOCA was 83°-89°; group C, TOCA>89°). The TOCA and C2-C7 Cobb angle in the preoperative and immediate postoperative and final follow-up in each group A, B and C, as well as in the control group, were collected for t-test and Pearson correlation analysis. Results: The mean value of TOCA in control was 86.2°±2.7°, and the C2-C7 Cobb angle was 17.4°±3.9°. In control and in preoperative and final follow-up of BI group, the TOCA and C2-C7 Cobb angle had positively correlated(P<0.05). In group A, the C2-C7 Cobb angle between the preoperative and final follow-up had no statistical difference(P>0.05), however, for C2-C7 Cobb angle in group A, the mean value was reduced from 15.4°±3.5° before surgery to 11.7°±2.6° at final follow-up. In group B, the C2-C7 Cobb angle between the pre-operative(20.0°±4.5°) and final follow-up(21.8°±4.7°) had no statistical difference(P>0.05), and in group C, the C2-C7 Cobb angle between preoperative(21.6°±2.3°) and final follow-up(30.0°±4.3°) had a statistical difference(P<0.05). Conclusions: During the craniocervical fusion in patients with BI, the TOCA should be fixed in the range of 83°-89°, it can reduce the impact on the curvature of the lower cervical spine.