强直性脊柱炎胸腰椎后凸畸形患者颈椎活动受限的相关因素及临床意义

Correlation and clinical significance of the decreased cervical mobility in ankylosing spondylitis patient with thoracolumbar kyphosis

中文关键词:  强直性脊柱炎  后凸畸形  颈椎活动度

英文关键词:Ankylosing spondylitis  Kyphosis  Cervical range of motion

中文摘要:

  【摘要】 目的：探讨强直性脊柱炎（ankylosing spondylitis，AS）胸腰椎后凸畸形患者颈椎活动受限的相关因素及临床意义。方法：从2012年5月~2012年10月在我院就诊的51例AS胸腰椎后凸畸形患者中，筛选出资料完整的患者38例，其中男36例，女2例；年龄17~53岁，平均32.6岁；病程3~37年，平均10.1年。收集患者的年龄、病程、血沉（ESR）、C反应蛋白（CRP）、全脊柱后凸最大Cobb角（global kyphosis，GK）、颈椎病变评分（mSASSS）、颈椎曲度、C2~C7矢状面平衡（SVA）、AS疾病活动性量表（bath ankylosing spondylitis disease activity index，BASDAI）、AS功能量表（bath ankylosing spondylitis functional index，BASFI）和Oswestry功能障碍指数（ODI）。根据颈椎活动度（cervical range of motion，CROM）测量结果分组：A组，CROM>40°；B组，CROM<20°。采用独立t检验，比较两组间上述各参数的差异性。对于有差异的参数采用Pearson相关性检验分析其与CROM之间的相关性，寻找CROM的高危因素。结果：A组16例，CROM为41°~92°，平均65.8°±14.3°；B组17例，CROM为1°~19°，平均9.2°±6.6°。两组病程、BASFI、GK、mSASSS、颈椎曲度及C2~C7 SVA有显著性差异（P<0.05），而年龄、ODI、BASDAI、ESR、CRP无显著性差异（P>0.05）。病程、颈椎mSASSS、颈椎曲度、C2~C7 SVA及BASFI与CROM均有显著相关性（r分别为-0.524、-0.895、0.494、-0.813、-0.501，P<0.05），GK与CROM无显著相关性（r=-0.275，P=0.122）。结论：较长病程和颈椎结构性损害是AS颈椎活动受限的主要相关因素，AS颈椎活动受限显著降低了患者的生活质量。

英文摘要:

  【Abstract】 Objectives: To investigate the risk factors and its clinical significance of limited cervical range of motion in ankylosing spondylitis(AS) patients with thoracolumbar kyphosis. Methods: From May 2012 to October 2012, 38 AS patients(with complete medical records) from the 51 consecutive AS patients with thoracolumbar kyphosis in our hospital were enrolled. There were 36 males and 2 females, with an average age of 32.6 years(range, 17-53 years). The clinical data consisted of age, disease course, erythrocyte sedimentation rate(ESR), C-reaction protein(CRP). The radiographic parameters were composed by global kyphosis(GK), cervical mSASSS(the modified Stokes ankylosing spondylitis spinal score), cervical curve and C2-C7 SVA. The quality of life questionnaires consisted of bath ankylosing spondylitis disease activity index(BASDAI), bath ankylosing spondylitis functional index(BASFI) and Oswestry disability index(ODI). According to the value of cervical range of motion(CROM), the subjects were divided into two groups: group A, CROM >40°; group B, CROM <20°. The independent t-test was used to compare the parameters between the two groups. Furthermore, the Pearson correlation test was performed to investigate the risk factors correlated with CROM. Results: In group A, there were 16 patients with an average CROM of 65.8°±14.3°(41°-92°), while 17 patients in group B with an average CROM of 9.2°±6.6°(1°-19°). With respect to the disease course, BASFI, GK, mSASSS, cervical curve and C2-C7 SVA, significant differences were found between two groups(P<0.05). However, the age, ODI, BASDAI, ESR or CRP showed no significant difference between group A and B(P>0.05). There were remarkable correlations between CROM and disease course, mSASSS, cervical curve, C2-C7 SVA and BASFI(r=-0.524, -0.895, 0.494, -0.813, and -0.501 respectively, P<0.05). Especially, there was no significant correlation between GK and CROM(r=-0.275, P=0.122). Conclusions: Longer disease course and cervical structural damage are high risk factors of CROM in AS patients with thoracolumbar kyphosis. AS patients′ quality of life is severely affected by the limited cervical range of motion.