颈型颈椎病患者颈椎前倾及曲度改变与脊柱矢状位参数相关性分析

Correlation analysis of cervical anteversion and curvature changes with sagittal parameters in patients with cervical spondylosis

中文关键词:  颈型颈椎病  矢状位参数  相关性分析  影像学参数

英文关键词:Cervical spondylosis  Sagittal parameters  Correlation analysis  Imaging parameters

中文摘要:

  【摘要】 目的：首次使用颈椎前倾角评估颈椎前倾程度，并探讨和分析颈型颈椎病患者颈椎前倾程度与颈椎曲度改变和脊柱矢状位参数之间存在何种相关性。方法：将2020年5月~2023年7月在我院骨伤科颈椎专科门诊就诊的201例颈型颈椎病患者纳入研究，其中男79例（39%），女122例（61%），年龄25.6±6.5（18~40）岁。在全脊柱侧位X线片上测量颈椎参数，包括颈椎前凸角（cervical lordosis，CL）、上颈椎Cobb角、C1-7 Cobb角、T1斜率（T1 slope，T1S）、颈椎矢状轴（cervical sagittal vertical axis，cSVA）、颈椎曲度Borden值、颈椎前倾角（anterior tilt slope，ATS）；胸腰椎参数，包括胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）；骨盆参数，包括骶骨倾斜角（sacral slope，SS）、骨盆倾斜角（pelvic tilt，PT）、骨盆投射角（pelvic incidence，PI）、脊柱矢状轴（sagittal vertical axis，SVA）等。根据颈椎曲度Borden值及ATS对曲度改变、颈椎前倾进行分型，分析两种不同分型与脊柱矢状位参数的关系。结果：以ATS为参考值将颈椎前倾分为Ⅰ~Ⅳ型，其中Ⅰ型67例、Ⅱ型70例、Ⅲ型40例、Ⅳ型24例；以Borden值将颈椎曲度分为反弓型65例、变直型92例、前凸型29例、S型15例。所有受试者结果显示颈椎曲度Borden值与CL、C1-7 Cobb角、T1S存在显著正相关性（P＜0.001）。ATS与T1S、cSVA具有显著正相关性（P＜0.001），与CL、C1-7、Borden存在正相关性（P＜0.05）。SVA与C1-7、T1S、cSVA、Borden、ATS、SS呈显著正相关性（P＜0.001），而各颈椎参数与骨盆参数之间无明显相关性。不同颈椎前倾程度分型中cSVA、T1S、SVA、TK之间均存在显著性差异（P＜0.001），当前倾程度越严重时，会进一步加重矢状位失衡。而不同颈椎曲度分型中CL、C1-7、T1S、Borden、TK、SS、SVA、ATS均有统计学差异（P＜0.05），当曲度变直或反弓时会引起颈胸交界处代偿性减小。结论：颈型颈椎病患者的颈椎前倾程度与曲度改变主要与胸椎矢状位参数存在密切的相关性，当颈椎前倾加重和颈椎曲度的改变主要引起T1S和TK角代偿性改变，颈椎前倾明显的人群中的SVA明显增大。

英文摘要:

  【Abstract】 Objectives: To apply the anterior tilt slope(ATS) for the first time to assess the degree of cervical anteversion, and to explore and analyze the correlations between the cervical anteversion and cervical curvature changes and sagittal spinal alignment parameters in patients with cervical spondylosis. Methods: A total of 201 patients with cervical spondylosis who were treated in the Department of Orthopedics(Cervical Spine) outpatient clinic from May 2020 to July 2023 were included in the study, consisting of 79(39%) males and 122(61%) females, aged 25.6±6.5(18-40) years. Imaging parameters were measured on the total spinal lateral X-ray films, including the cervical parameters, such as cervical lordosis(CL), upper cervical Cobb angle, C1-7 Cobb angle, and T1 slope(T1S), cervical sagittal vertical axis(cSVA), Borden value of cervical curvature, anterior tilt slope(ATS); thoracolumbar parameters, such as thoracic kyphosis(TK) and lumbar lordosis(LL); as well as pelvic parameters, such as sacral slope(SS), pelvic tilt(PT), pelvic incidence(PI), sagittal vertical axis(SVA). The curvature changes and cervical anteversion were staged according to the Borden value and ATS in the cervical spine parameters, and their relationships with each spinal sagittal parameter in different classification were compared. Results: According to ATS, the cercical anteversion of patients was classified into type Ⅰof 67 cases, type Ⅱ of 70 cases, type Ⅲ of 40 cases, and type Ⅳ of 24 cases. According to the Borden value, the cervical curvature was classified into type kyphotic of 65 cases, type straight of 92 cases, type lordotic of 29 cases, and type sigmoid of 15 cases. There were significant positive correlations between Borden values and CL, C1-7 Cobb angle, and T1S(P<0.001). ATS had significant positive correlations with T1S and cSVA(P<0.001), and positive correlations with CL, C1-7 Cobb angle, and Borden value(P<0.05). SVA was significantly positively correlated with C1-7 Cobb angle, T1S, cSVA, Borden value, ATS, and SS(P<0.001), whereas there was no significant correlation between each of the cervical spine parameters and pelvic parameters. In different cervical anteversion classifications, significant differences were observed between cSVA, T1S, TK, and SVA(P<0.001), and severe degree of cervical anteversion further aggravated the sagittal imbalance. In different types of cervical curvature, there were significant differences between CL, C1-7 Cobb angle, T1S, Borden value, TK, SS, SVA, and ATS(P<0.05), and when the curvature straightened or became kyphotic, it would cause compensatory reduction of the cervicothoracic junction. Conclusions: In patients with cervical spondylosis, cervical anteversion and curvature changes exhibit significant correlations with thoracic parameters among the sagittal parameters. When cervical anteversion is aggravated and changes in cervical curvature mainly cause compensatory changes in the T1S and TK angles, the SVA is significantly larger in those with significant cervical anteversion.