无症状成人颈椎矢状位曲度分析及其与全脊柱矢状位参数的关系

Analysis of the cervical spine alignment and its correlation with spino-pelvic balance in asymptomatic young adults

目的：探讨正常亚洲黄种人群颈椎矢状位曲度及其与全脊柱矢状位参数的关系.方法：采用影像学分析对132名成人无症状志愿者进行研究,所有志愿者行全脊柱正、侧位X线检查及中立位颈椎侧位片,测量颈椎矢状位参数包括C0-C2角（Occiput-C2 angle）、C2-C7角（C2-C7 angle）、C2-C7矢状面轴向距离（sagittal vertical axis,SVA）、头部重心（center gravity of head,CGH）-C7 SVA（CGH-C7 SVA）、C2-CGH SVA,和胸椎矢状位参数：T1倾斜角（T1 slope）、胸椎后凸角（thoracic kyphosis,TK）,脊柱-骨盆的方向性参数：腰椎前凸角（lumbar lordosis,LL）、骨盆入射角（pelvic incidence,PI）、骶骨倾斜角（sacral slope,SS）及全脊柱矢状位参数：脊柱骶骨角（spinal sacral angle,SSA）、C7-S1的矢状面轴向距离（C7-S1 SVA）.使用Toyama等颈椎矢状位序列分型方法将所有志愿者分为三组：前凸组,后凸组,变直或鹅颈畸形组,并比较三组人群各参数间差异.使用皮尔逊相关分析和单因素ANOVA分析相关数据.结果：C0-C2角的平均值是15.13°176±6.69°，C2-C7角的平均值是12.03°1±7.64°。C2-C7 SVA平均值是18.67±7.96mm,CGH-C7 SVA的平均值是22.95±12.18mm,CGH-C2 SVA的平均值是7.08±5.38mm,T1 slope平均值是26.33°176±7.01°三组志愿者中,前凸组共43名（占32.6％）,变直或鹅颈畸形组共74名（占56.1％）,后凸组15名（占11.3％）.C2-C7角与T1 slope （r=-0.422）相关,T1 slope与TK（r=0.434）、TK与LL（r=0.574）,LL与SS （r=0.459）,SS与PI （r=0.727）相关.三种志愿者中C2-C7角,CGH-C7SVA,T1 slope,TK在三组间两两比较均有显著统计学差异.结论：部分无症状成人亦存在颈椎的变直或鹅颈畸形甚至后凸改变.颈椎后凸表现可能更多的是一个局部问题而非整体脊柱骨盆参数异常.

Objectives： To describe the normal range of cervical sagittal parameters in Asian Yellow People, to analyze the factors determining cervical spine sagittal balance and compare the parameters among four types of cervical spine. Methods： A prospective radiographic study on 132 asymptomatic young volunteers without the history of symptoms related to whole spine was carried out. Cervical and whole-spine standing lateral radiographs were taken to analyze the following parameters： spino-pelvic parameters including pelvic incidence（PI）, sacral slope（SS）, lumbar lordosis（LL）, and sagittal thoracic parameters including thoracic kypho- sis（TK）, T1 slope; and cervical spine parameters including C0-C2, C2-C7 angles and C2-C7 SVA, CGH-C7 SVA, CGH-C2 SVA, and global spine parameters. Statistical analysis was performed by using the spinal sacral angle （SSA）, C7-S1 SVA. Three groups were assigned according to Toyama method： lordosis group, kyphosis group, straight or sigmoid group. Pearson correlation coefficients and one-way-ANOVA（Student-New- man-Keuls test） were used. Results： All the parameters showed a normal distribution. The mean C0-C2 angle was 15.13°±6.69°, and the mean C2-C7 angle was 12.03°±7.64°. The mean C2-C7 SVA was 18.67±7.96mm, and the mean CGH-C7 SVA was 22.95±12.18mm, and the mean CGH-C2 SVA was 7.08°-5.38mm. The meanT1 slope was 26.33°±7.01°. In 3 groups, lordosis group had 43 （32.6%）, straight or sigmoid group had 74 （56.1%）, kyphosis group had 15（11.3%）. There was a significant sequential linkage between C0-C2 angle and C2-C7 angle（r=-0.277）, C2-C7 angle and T1 slope（r=0.422）, T1 slope and TK（r=0.434）, TK and LL（r=0.574）, LL and SS（r=0.459）, SS and PI（r=0.727）. C2-C7 angle, CGH-C7 SVA, T1 slope, TK showed significant differenees among the three groups of cervieal alignment. Conclusions： Cervieal lordosis is not the only presentation in asymptomatie subjects. The eervieal alignment eorrelates with the gravity of head and thoracic kyphosis, and eervieal kyphosis may be a local problem rather than the global spine and pelvis parameter anomaly.