寰枢关节不稳或脱位患者上颈椎曲度改变对下颈椎的影响

The influence of occipitoaxial alignment on subaxial cervical spine in patients with atlantoxial dislocation and instability

目的:探讨寰枢关节不稳或脱位患者上颈椎的曲度变化对下颈椎力线和退变的影响。方法:在148例寰枢关节不稳定或脱位患者的颈椎中立位X线片上测量C0-1、C1-2、C0-2及C2-7角度,评估颈椎间盘的退变程度。分析上、下颈椎曲度之间以及颈椎曲度与年龄、病程之间的相关性,观察不同年龄组上颈椎曲度对下颈椎椎间盘退行变的影响。结果:C0-1角度为-22.9°～18.6°(n=88);C1-2角度为-31.7°～39.1°(n=88);C0-2角度为-35.2°～44.8°(n=148);C2-7角度为-17.4°～77.8°(n=148)。C1-2和C2-7角度之间、C0-2与C2-7角度间、C0-1与C1-2角度之间存在显著负相关性。上、下颈椎曲度与病程、年龄无相关性。30～39岁组、40～49岁组及50～59岁组C5/6椎间盘退变、60岁以上组C2/3椎间盘退变与上颈椎角度(C0-2角度)之间存在显著负相关。结论:上、下颈椎曲度间存在密切关系,寰椎前脱位可导致下颈椎出现代偿性过度前凸,即鹅颈畸形,鹅颈畸形可能加速下颈椎的退变进程。

Objective：To explore the impact of alignment of occipitoaxial on alignment and degeneration of subaxial cervical spine in patients with atlantoaxial subluxation and dislocation.Method：Angles of C0-C1,C1- C2,C0-C2 and C2-C7 were measured in 148 cases with atlantoaxial dislocation.The relationship between alignment of occipitoaxial and subaxial cervical spine was evaluated,as well as age-related and course-related cervical alignment.The relation between upper cervical alignment and cervical disc degeneration were reviewed on different age group.Result：The angle at C0-1 was -22.9°-18.6°（n=88）, C1-2 of -31.7°-39.1°（n=88）;C0- 2 of-35.2°-44.8°（n=148） ;C2-7 of -17.4°-77.8°（n=148）.Statistically significant correlations were observed between the angles of C1-C2 and C2-C7,C0-C2 and C2-C7,and CO-C1 and C1-C2 respectively.The admission age was no significant correlative to the angles of C1-C2,C0-C2 and C2-CT,as well as the disease course. While in the group of 30-39 years,40-49 years and 50-59 years,CS/6 disc degeneration was significant negative correlative to the C0-C2 angles,and in the group of over 60 years,C2/3 disc degeneration was significant negative correlative to the C0-C2 angles.Conclusion：The alignment of subaxial cervical spine is significant correlative to upper cervical spine.Anterior dislocation of the atlas will lead to compensatory hyperlordosis at subsxial cervical spine,which will present a ＂swan neck＂ deformity.This complex of deformity may subse- quently accelerate the subaxial spine degeneration.