脊髓型颈椎病术前矢状面影像学参数特点及相互关系

Correlation among preoperative parameters of sagittal alignment in cervical spondylotic myelopathy

[目的]测量脊髓型颈椎病患者术前矢状面影像学参数,探讨各参数间关系及其变化特征在疾病进展中的临床意义。[方法]回顾性分析2015年6月～2017年7月在东南大学附属中大医院诊断为脊髓型颈椎病的住院患者临床和影像学资料。统计患者性别、年龄及日本骨科协会颈髓功能评分(JOA),收集侧位X线片各矢状面平衡参数,使用Spearman检验进行相关性分析,探究各矢状面平衡参数间的相关性。[结果]共纳入141例患者,年龄平均(54.34±10.79)岁,男99例,女42例。各参数两性别间的差异均无统计学意义(P>0.05)。C_2～C_(7 )SVA与C_(2～7)角(r=-0.350,P<0.001)呈显著负相关,与C_7倾斜角(r=0.357,P<0.001)、C_2倾斜角(r=0.621,P<0.001)、C_(0-2)角(r=0.275,P=0.001)、C_(1-2)角(r=0.207,p=0.014)、TIA(r=0.296,P<0.001)呈显著正相关;TIA与C_7倾斜角(r=0.246,P<0.05)之间呈正相关;C_(2～7)角与C_7倾斜角呈正相关(r=0.505,P<0.001),与C_(0-2)角(r=-0.186,P<0.05)、C_(1-2)角呈负相关(r=-0.231,P<0.05)。当C_(2～7)≤7°时,C_(2～7)角与C_(0-2)角、C_(1-2)角之间无相关性(P>0.05),而当C_(2～7)>7°时,C_(2～7)角与C_(0-2)(r=-0.370,P<0.001)、C_(1-2)(r=-0.326,P<0.05,)呈负相关;同时,两种角度之间的C_2-C_(7 )SVA差异有统计学意义(P<0.05)。[结论]脊髓型颈椎病患者术前矢状面参数之间存在相关性,但上下颈椎间参数的相关性存在一定的动态变化,实现对矢状面失衡的代偿。

[Objectives] To measure the preoperative sagittal imaging parameters in patients with cervical spondylotic myelopathy, and explore the clinical significance of the relationship between various parameters and their changing characteristics in disease progression. [Methods] A retrospective study was conducted on clinical and imaging data of inpatients who were diagnosed as cervical spondylotic myelopathy at Zhongda Hospital, Southeast University from June 2015 to July 2017. The parameters on sagittal plane were measured from the lateral radiographs. Spearman correlation analysis was conducted to explore the correlations between the sagittal balance parameters of the upper and lower cervical spine. [Results] A total of 141 patients were enrolled, including 99 males and 42 females with an average age of（54.34±10.79） years. There were no statistically significant differences regarding to any sagittal parameters between the two genders（P〈0.05）. The C2～C7 SVA proved significantly negative correlation with the C2-C7 angle（r=-0.350, P〈0.001）, whereas statistically positive correlations with C7 slope（r=0.357,P〈0.001）, C2 slope（r=0.621, P〈0.001）, C0-2 angle（r=0.275, P=0.001）, C1-2 angle（r=0.207, P〈0.014）, and thoracic inlet angle（TIA）（r=0.296, P〈0.001）. In addition, the TIA displayed significant positive correlation with C7 slope（r=0.246, P=0.003）.The C2-C7 angle was positively correlated to the C7 slope（r=0.505, P〈0.001）, while negatively correlated to the C2 slope（r=-0.186, P=0.027） and C1-2 angle（r=-0.231, P=0.006）. In term of dynamic assessment, no significant correlations were found between C2-C7 angle and C0-2 angle or C1-2 angle if the C2-C7 angle was ≤ 7°（P〈0.05）, whereas statistically significant negative correlations were noticed between the C2-C7 angle and C0-2 angle（r=-0.370, P〈0.001）, as well as C1-2 angle（r=-0.326, P=0.001） if the C（2-7） angle was 7°. In other hand,the C（2-7） SVA proved significantly different between the two dynamic positions（P=0.009）. [Conclusion] There are correlations between preoperative sagittal parameters in cervical spondylotic myelopathy. The dynamic variations in the correlations between the parameters of the upper and lower cervical spine should be compensative for sagittal imbalance.