150例健康成人枕颈角和后枕颈角影像参数测量及其临床意义

Measurement and clinical significance of occipito-C2 angle and posterior occipitocervical angle in 150 healthy adults

中文关键词:  健康成人  枕颈角  后枕颈角  相关性  临床意义

英文关键词:Healthy adults  Occipito-C2 angle  Posterior occipitocervical angle  Correlation  Clinical significance

中文摘要:

  【摘要】 目的：测量分析我国健康成人枕颈角（occipital-C2 angle，OC2A）和后枕颈角（posterior occipitocervical angle，POCA）影像学参数，分析两者与性别、年龄之间差异的变化情况，为后路枕颈固定融合术提供参考。方法：在我院体检中心随机筛选健康（无颈椎疾病及相关症状）志愿者，行标准颈椎正侧位X线平片检查，按照不同性别分为男女组各75例，各性别组根据不同年龄段分5个组：20~29岁、30~39岁、40~49岁、50~59岁、60~69岁各15例。3名脊柱外科主治医生2次不同时间分别独自对健康体检者OC2A和POCA进行测量，采用组内相关系数评价观察者间和观察者内测量的可信度。获取我国健康成人OC2A和POCA参数值并进一步行两者随性别、年龄之间变化的统计学分析和两参数组内相关系数（intraclass correlation coefficient，ICC）分析。结果：150例健康成人OC2A、POCA分别为14.14°±3.70°、108.53°±7.80°，95%置信区间（confidence intervals，CI）分别为6.89°~21.39°、93.24°~123.82°；男性组OC2A和POCA分别为14.63°±3.10°、108.05°±7.48°，女性组OC2A和POCA分别为13.66°±4.18°、109.01°±8.14°，男女组之间OC2A和POCA差异无统计学意义（P＞0.05）。各性别组年龄段之间OC2A差异无统计学意义[男P=0.129，女P=0.160，One-Way ANOVA（LSD）]，男性组60~69岁组POCA较20~29岁组和50~59岁组低（P＜0.05）；女性组30岁以后POCA持续减小，60~69岁组小于20~29岁组，差异均有统计学意义（P＜0.05）。Pearson相关分析显示OC2A与POCA负相关（r=-0.386，P＜0.001）。OC2A和POCA测量值在观察者间组内ICC分别为0.933和0.971，观察者内的ICC分别为0.916和0.935，P＜0.001。结论：我国健康成人OC2A和POCA值在性别之间无差异；OC2A值在各年龄段之间无变化，但POCA值随年龄增大而减小。术者可结合患者年龄，参考两参数的CI值及其负相关，确立后路枕颈固定融合术中OC2A和POCA角度的选择。

英文摘要:

  【Abstract】 Objectives: To measure the occipito-C2 angle(OC2A) and the posterior occipitocervical angle(POCA) in healthy Chinese adults and analyze their differences and clinical significance with regard to sex and age, so as to provide the oretical guidance and reference for the posterior occipitocervical fusion. Methods: A total of 150 healthy subjects without cervical spine disease(healthy group) was recruited(male:female=1:1). Each gender group was furtherly evenly divided into 5 groups according to the age, 20-29 year-old group, 30-39 year-old group, 40-49 year-old group, 50-59 year-old group, 60-69 year-old group. 3 spine surgeons measured the OC2A and POCA of the subjects twice respectively. The intraobserver and interobserver reliabilities were evaluated by the intra-class correlation coefficient. Statistical analysis was done to compare the OC2A and POCA between different gender and age group respectively. Results: The value of OC2A and POCA in 150 subjects was 14.14°±3.70° and 108.53°±7.80°, respectively. The 95% confidence intervals(CI) were 6.89°-21.39° and 93.24°-123.82°, respectively. The value of OC2A and POCA in male was 14.63°±3.10° and 108.05°±7.48°, and 13.66°±4.18° and 109.01°±8.14° were measured in female. There was no significant difference of OC2A between each gender or age group[male P=0.129, female P=0.160, One-Way ANOVA(LSD)]. In male, POCA in 60-69 year-old group was less than 20-29 and 50-59 year-old groups. But in female, POCA decreased with age after 30 year-old, and the 60-69 year-old group was significantly less than the 20-49 year-old group with regard to POCA. Pearson correlation analysis showed that there was a negative correlation(r=-0.386, P<0.001) between OC2A and POCA. The correlation coefficients(ICC) of intraobserver measurement of OC2A and POCA were 0.933 and 0.971 respectively, and the ICCs of interobserver were 0.916 and 0.935 respectively， P＜0.001. Conclusions: There is no significant difference of OC2A or POCA between male and female in heathy Chinese adults. The OC2A value is approximately the same among all age groups, while the POCA value decreases with age. Spine surgeons can consider the age of the patientsand refer to the CI value and negative correlation of the two parameters, thus to make better choice of the OC2A and POCA angles selection in posterior occipitocervical fusion.