青少年特发性脊柱侧凸患者上颈椎序列变化特点及各参数间的相关性

Parameters of upper cervical alignment and their relationship in adolescent idiopathic scoliosis

目的:测量青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者上颈椎序列参数,探讨各参数间的相关关系及其在维持前视平衡中所起的作用。方法:回顾性分析2014年1月~2016年1月期间就诊的196例AIS患者,排除其中资料不全者、接受过治疗者、患有影响脊柱序列疾病者以及上胸段脊柱侧凸累及颈段者,共有103例患者纳入研究,其中男26例,女77例,年龄10~17岁(14.66±2.31岁)。在脊柱侧位X线片上测量颈椎Cobb角(cervical Cobb angle,CCA)、C0-C2角(occiput-C2 angle)、C1-C2角(C1-C2 angle)、硬腭-C2角(palatum-C2 angle)、C2椎体轮廓线(C2 vertebra contour angle)、C1-C7矢状面轴向距离(C1-C7 SVA)、T2倾斜角(T2 sagittal tilt)。根据Lenke胸椎修正分型(修正+、修正N、修正-)将患者分为(+)、N、(-)3组,比较各组间参数的差异性以及各参数间的相关性。结果:颈椎Cobb角10.29°±8.65°;C0-C2角13.86°±8.33°;C1-C2角25.61°±9.17°;硬腭-C2角12.06°±8.91°;C2椎体轮廓线98.43°±6.75°;C1-C7矢状面轴向距离28.41±10.69mm;T2倾斜角10.73°±8.11°。在Lenke胸椎修正分组中颈椎Cobb角及T2倾斜角在各组间有统计学差异(P<0.05)。C0-C2角、C1-C2角、C1-C7矢状面轴向距离、硬腭-C2角相互之间有显著性正相关(P<0.01)。结论:AIS患者的T2倾斜角很大程度上受到T5~T12后凸的影响。当AIS患者的颈椎在矢状位发生位移减少时,机体可通过减小C1-C2角来维持前视平衡。

Objectives： To explore the parameters of upper cervical alignment and their relationship in the adolescent idiopathic scoliosis（AIS）, and to clarify the parameters effect on forward-vision balance. Methods： 196 AIS patients who visited our hospital between January 2014 and January 2016 were reviewed. Patients who had incomplete information, spinal disease and spinal treatment history were excluded. Patients with upper thoracic scoliosis extending to cervical segment were also excluded. As a result, a total of 103 patients were studied in this study, including 26 males and 77 females, with an average age of 14.66±2.31 years （range, 10-17 years）. The cervical Cobb angle（CCA）, occiput-C2 angle, C1-C2 angle, palatum-C2 angle, C2 vertebra contour angle, C1-C7 SVA, T2 sagittal tilt were measured on full-length spinal X-ray. According to the 3 different Lenke thoracic modifiers （modifier ＋, modifier N, modifier -）, patients were divided into 3 groups. All parameters were compared among the three groups. Correlation between the parameters was analyzed. Results： The mean values of CCA, occiput-C2 angle, C1-C2 angle, palatum-C2 angle, C2 vertebra contour angle, C1-C7 SVA and T2 sagittal tilt were 10.29°±8.65°, 13.86°±8.33°, 25.61°±9.17°, 12.06°±8.91°, 98.43°±6.75°, 28.41±10.69mm and 10.73°±8.11°, respectively. CCA and T2 sagittal tilt had significant difference（P〈0.05） among the groups according to the Lenke thoracic modifier. The occiput-C2 angle, C1-C2 angle, palatum-C2 angle, C1-C7 SVA had significant positive correlations （P〈0.01） between each other. Conclusions： T2 sagittal tilt is affected greatly by the kyphosis of T5-T12 in AIS. If cervical sagittal vertical axis decreased, upper cervical will decrease the C1-C2 angle to maintain forward-vision balance. Upper cervical alignment is one of the most important factors for adjusting forward-vision balance.