颈腰痛患者颈椎矢状位序列的代偿机制

Compensatory mechanism of cervical sagittal alignment in patients with neck-low back pain

背景:颈痛是非常常见的症状,但对于颈痛的病因诊断仍然困难,颈痛和颈椎矢状位序列之间的关系仍旧有很多争议。目的:探讨颈腰痛患者颈椎矢状位序列可能存在的代偿机制。方法:颈腰痛患者行站立位颈腰椎正侧位X射线检查。对照组为单纯颈痛患者、无颈部症状志愿者,行颈椎正侧位X射线检查,每组50人。测量颈-胸椎矢状位形态及序列参数包括C0-C2角、C2-C7角、C2-C7矢状面轴向距离、头部重心-C7矢状面轴向距离、T1倾斜角。所有参数均采用95%可信区间表示,各组所测参数以及C0-C2角+C2-C7角、C2-C7矢状面轴向距离与头部重心-C7矢状面轴向距离之间的距离分别进行t检验对比分析。结果与结论:(1)颈腰痛患者C0-C2角为12.4°-20.7°,C2-C7角为5.6°-15.1°,T1倾斜角为21.3°-25.8°,C2-C7矢状面轴向距离为14.2-20.8 mm,头部重心-C7矢状面轴向距离为9.5-17.5 mm,C0-C2角+C2-C7角为23.1°-30.7°,C2-C7矢状面轴向距离与头部重心-C7矢状面轴向距离之间的距离为1.4-6.6 mm;(2)颈痛患者C0-C2角的值为15.6°-18.6°,C2-C7角的值为7.7°-13.1°,T1倾斜角的值为23.1°-26.0°,C2-C7矢状面轴向距离值为13.5-17.7 mm,头部重心-C7矢状面轴向距离值为10.5-17.2 mm,C0-C2角+C2-C7角的值为25.3°-29.6°,C2-C7矢状面轴向距离与头部重心-C7矢状面轴向距离之间的距离为-0.5-4.6 mm;(3)无症状志愿者C0-C2角为11.8°-17.9°,C2-C7角为7.7°-13.9°,T1倾斜角为21.7°-24.5°,C2-C7矢状面轴向距离值为12.1-18.5 mm,头部重心-C7矢状面轴向距离为6.4-15.3 mm,C0-C2角+C2-C7角为24.1°-28.8°,C2-C7矢状面轴向距离与头部重心-C7矢状面轴向距离之间的距离为1.9-7.4 mm;(4)各组内男女之间各参数差异无显著性意义(P>0.05),组间各参数之间差异也无显著性意义(P>0.05);(5)综上,颈腰痛患者、单纯颈痛患者和无症状者颈椎矢状位所测参数无明显差异,颈腰痛患者的颈椎矢状位序列代偿无特异性,还需要进一步寻求更为敏感的矢状位参数。

BACKGROUND： Neck pain is a very common symptom, but it is still difficult to diagnose the etiology of neck pain. The relationship between neck pain and cervical sagittal alignment remains controversial.OBJECTIVE： To investigate the possible compensatory mechanism of cervical sagittal alignment in patients with neck-low back pain. METHODS： The patients with neck-low back pain were examined by neck and lumbar X-ray. The control group contained the patients with neck pain and without volunteers with cervical symptoms. The X-ray examination of the cervical spine was performed. Each group included 50 patients. Cervical-thoracic lateral radiographs were taken to analyze the following parameters： Occiput-C2 angle; C2-C7 angle; C2-C7 sagittal vertical axial（SVA）,（center gravity of head, CGH）-C7 SVA; T1 slope. All parameters were expressed by 95% confidence interval, and the C0-C2 angle, C2-C7 angle, C2-C7 SVA and CGH-G7 SVA distance between groups were analyzed by t test. RESULTS AND CONCLUSION：（1） The value of the Occiput-C2 angle was 12.4°-20.7°; C2-C7 angle was 5.6°-15.1°; T1 slope was 21.3°-25.8°; C2-C7 SVA was 14.2-20.8 mm; CGH-C7 SVA was 9.5-17.5 mm; C0-C2 angle ＋ C2-C7 angle was 23.1°-30.7°; C2-C7 SVA-CGH-C7 SVA was 1.4-6.6 mm in patients with neck-low back pain.（2） The value of the Occiput-C2 angle was 15.6°-18.6°; C2-C7 angle was 7.7°-13.1°; T1 slope was 23.1°-26.0°; C2-C7 SVA was 13.5-17.7 mm; CGH-C7 SVA was 10.5-17.2 mm; C0-C2 angle ＋ C2-C7 angle was 25.3°-29.6°; C2-C7 SVA-CGH-C7 SVA was-0.5-4.6 mm in patients with neck back pain.（3） The Occiput-C2 angle was 11.8°-17.9°; C2-C7 angle was 7.7°-13.9°; T1 slope was 21.7°-24.5°; C2-C7 SVA was 12.1-18.5 mm; CGH-C7 SVA was 6.4-15.3 mm; C0-C2 angle ＋ C2-C7 angle was 24.1°-28.8°; the distance between C2-C7 SVA and CGH-C7 SVA was 1.9-7.4 mm in patients without symptoms.（4） There was no statistical significance in each parameter between males and females in each group（P 0.05）; and no significant difference in each parameter was determined between groups（P 0.05）.（5） In summary, there were no significant differences in the sagittal cervical parameters among patients with neck-low back pain and those with neck pain and those without symptoms. There was no specificity in the sagittal alignment compensation of the cervical spine in patients with neck-low back pain. More sensitive sagittal parameters should be studied.