摘要
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.
作者
张光明
阮志勇
胡荣胜
陈农
高如峰
潘福根
Zhang Guang-ming;Ruan Zhi-yong;Hu Rong-sheng;Chen Nong;Gao Ru-feng;Pan Fu-gen(Department of Orthopedics,Qingpu Branch,Zhongshan Hospital Affiliated to Fudan University,Shanghai 201700,China)
出处
《中国组织工程研究》
CAS
北大核心
2018年第19期3072-3076,共5页
Chinese Journal of Tissue Engineering Research