颈椎矢状力线参数和颈椎间盘退变的关系
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上海交大医学院附属第九人民医院

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R681.5

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Correlation of cervical sagittal alignment and cervical disc degeneration
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1.Department of Orthopaedic Surgery,Shanghai Ninth People'2.'3.s Hospital,Shanghai Jiaotong University, School of Medicine

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    摘要:

    目的 探讨颈椎矢状力线和颈椎间盘退变的关系 方法 回顾分析 2016 年 8月~2017年8月60例颈椎退行性疾病患者,其中男 25 例,女35例,年龄51~68岁,平均 61岁,病程 5~13个月,平均 9.6个月。所有患者拍摄颈椎侧位 X 线片以及颈椎MR,依据Pfirrmann分级评定椎间盘退变;利用院内影像归档与通信系统测量矢状面参数:矢状面位移(SVA)、颈椎前凸角(CL)、颈倾斜角(NT)、胸廓入射角(TIA)、T1倾斜角(T1S)。按 T1S值分组(A 、B 组),分组比较对椎间盘退变的影响。按椎间盘退变程度分组(N、M组),比较矢状面参数对颈椎间盘退变的影响。 结果 大T1倾角组各节段对应椎间盘退变等级分别为C2-3对应2.55,C3-4对应2.70,C4-5对应2.88,C5-6对应2.88,C6-7对应2.24。小T1倾角组各节段对应椎间盘退变等级分别为C2-3对应2.45,C3-4对应2.65,C4-5对应2.79,C5-6对应3.20,C6-7对应2.75。C5-6、C6-7退变明显加重,差异有统计学意义(P<0.05); C2-3,C3-4,C4-5退变无明显差异(P>0.05)。N、M组TIA 、T1S、NT分别为(75.8±9.2°,23.5±7.1°,52.1±9.6°)和(76.5±9.6°,23.2±6.7°,53.6±8.4°),差异无统计学意义(P>0.05); CL、C2-7SVA分别为 (18.8±6.1°,15.1±8.5 mm)和(13.2±5.3°,20.2±11.4 mm),差异有统计学意义(p<0.05)。结论 颈椎矢状力线对颈椎椎间盘退变具有重要影响,低T1S可导致C5-6和C6-7椎间盘的退变。

    Abstract:

    Objective: The purpose of this study was to analyze the relationship of T1 slope as well as other sagittal balance parameters with degree of degeneration in patients with cervical disc degeneration. Methods: From August 2016 to August 2017, 60 patients of cervical degenerative diseases had conformed to the selection criteria, including 25 males and 35 females, whose age was between 51 to 68 years old (average of 61) having 5~13 months (average of 9.6) courses of disease. All patients had taken lateral X-ray and MR of cervical spine. The diseased intervertebral disc degeneration grades were classified according to Pfirrmann evaluation system. Based on Picture Archiving and Communication System(PACS), the following cervical sagittal balance parameters were measured : Sagittal Vertical Axis (C2-7SVA), Cervical Lordosis angel (CL), Thoracic inlet angle (TIA), neck tilt (NT), T1-Slope (T1S). From T1S measurement values, all the patients were divided into 2 groups, i.e. Group A (less than 25 degrees) and Group B (over 25 degrees) to compare the different cervical intervertebral disc of segments degeneration grades. Via segments degeneration grades measurement values, all the patients were also divided into another 2 groups, Group N and Group M,to compare with the sagittal balance parameters. Results: In low T1 slope group, average degeneration grade of each cervical segment was 2.45 in C2-3, 2.65 in C3-4, 2.79 in C4-5, 3.20 in C5-6, and 2.75 in C6-7. And that of high T1 group was 2.55 in C2-3, 2.70 in C3-4, 2.88 in C4-5, 2.88 in C5-6, and 2.24 in C6-7. Grade of degeneration of low T1 group was significantly higher, as compared with high T1 group in C5-6 and C6-7 (p<0.05). Among groups A and B, no statistic significant difference was shown with C2-3, C3-4 and C4-5 disc degeneration. There was also statistic significant difference in other cervical sagittal balance parameters (P<0.05) with C5-6 and C6-7 disc degeneration. In group N,TIA,TIS,NT,CL and C2-7SVA were respectively 75.8±9.2°,23.5±7.1°,52.1±9.6°, 18.8±6.1°and 15.1±8.5 mm, while in group M, TIA,TIS,NT,CL and C2-7SVA were respectively 76.5±9.6°, 23.2±6.7°,53.6±8.4°, 13.2±5.3°and 20.2±11.4 mm. Among groups M and N, no statistic significant difference was shown with TIA, TIS and NT, (p>0.05)but statistic significant difference was shown with CL and C2-7SVA. (p<0.05) Conclusion:Cervical sagittal alignment has great impact on cervical intervertebral disc degeneration. Low T1 slope is a potential risk factor of cervical spondylosis especially in the C5-6 and C6-7 cervical segment.

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  • 收稿日期:2018-12-09
  • 最后修改日期:2019-04-24
  • 录用日期:2019-05-10
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