颈椎间盘退变程度与颈椎矢状力线参数的相关性分析

Correlation analysis between the degree of cervical disc degeneration and the parameters of cervical sagittal force line

目的探讨颈椎间盘退变程度与颈椎矢状力线参数变化的相关性,为颈椎退行性疾病的防治提供参考。方法自2017年9月-2018年9月纳入52例颈椎退行性疾病患者,通过X线测量其颈椎矢状力线参数,采用MRI检查评价颈椎间盘退变的Pfirrmann分级情况。颈椎矢状力线参数包括:T1倾斜角(T1slope,T1S)、颈椎前凸角(Cervical lordosis angle,CLA)、颈倾斜角(neck tilt,NT)、胸廓入口角(thoracic inlet angle,TIA)和颈椎矢状面轴向垂直距离(C2-C7sagittal vertical axis,C2-7SVA);Pfirrmann分级共Ⅰ~Ⅴ级,分别设定为1-5分,对C2-C7中5个节段分别进行Pfirrmann分级评分,总分为5~25分。对不同Pfirrmann分级与颈椎矢状力线参数的相关性进行Spearman分析。结果(1)以52例患者的各项矢状力线参数中位值为界限,将5项参数各分为≥中位值和<中位值的亚组共5组,比较各亚组内C2-C7所有节段的Pfirrmann分级评分:T1S亚组中的C5-6、C6-7节段Pfirrmann评分、CLA亚组的所有节段Pfirrmann评分,以及C2-7SVA亚组的所有节段Pfirrmann评分均有显著的组内差异(P<0.05);(2)以Pfirrmann评分<15分作为轻度退变,≥15分为中重度退变进行分组,Pfirrmann≥15分组的T1S、CLA值显著低于Pfirrmann<15分组,NT和C2-7SVA显著高于Pfirrmann<15分组,组间差异均有统计学意义(P<0.05)。(3)Spearman相关性分析显示,CLA与颈椎间盘退变Pfiffmann评分之间呈显著的负相关关系(r=-0.618,P=0.004);C2-7SVA则与之呈显著的正相关关系(r=0.725,P=0.001)。结论颈椎间盘退变人群的颈椎矢状力线参数可发生明显变化,其中CLA与颈椎间盘退变Pfiffmann评分之间呈显著的负相关关系,C2-7SVA则与之呈显著的正相关关系。

Objective To explore the correlation between the degree of cervical disc degeneration and the changes of sagittal force line parameters of cervical spine,so as to provide reference for the prevention and treatment of cervical degenerative diseases.Methods From September 2017 to September 2018,52 patients admitted to our department with cervical degenerative diseases were measured by X-ray,and Pfirrmann grading of cervical disc degeneration was evaluated by MRI examination.Cervical sagittal alignment lines of force parameters included T1 slope(T1 S),cervical lordosis angle(CLA),neck tilt(NT),thoracic inlet angle(TIA)and cervical sagittal axial vertical distance(C2-C7 sagittal vertical axis,C2-7 SVA).Pfirrmann gradingⅠ~Ⅴlevels,and were set as 1~5 points,respectively.In the C2-C7 Pfirrmann grading scores with five segments respectively,the total score was 5~25 points.Spearman analysis was performed on the correlation between different Pfirrmann grades and sagittal force line parameters of cervical spine.Results(1)In52 patients of the sagittal median value of boundary line of force parameters,the five parameters could be divided into≥the median value and<the median value of the group a total of 5,compared various subgroups within the C2-C7 Pfirrmann grading scores all segments:T1S subgroups of C5-6,C6-7 segment Pfirrmann grading,CLA all subgroups of the segmental Pfirrmann grading,and C2-7 SVA subgroup Pfirrmann grading all of the segments within the group had significant differences(P<0.05);(2)Pfirrmann score<15 was considered as mild degeneration and≥15 as moderate and severe degeneration.T1S and CLA values of Pfirrmann≥15 were significantly lower than those of Pfirrmann<15,and NT and C2-7 SVA were significantly higher than those of Pfirrmann<15,with statistically significant differences between the two groups(P<0.05).Spearman correlation analysis showed that CLA had significantly negative correlation with Pfiffmann score of cervical disc degeneration(r=-0.618,P=0.004).C2-7 SVA showed significantly positive correlation with it(r=0.725,P=0.001).Conclusion Cervical sagittal force line parameters may have significant changes in patients with cervical disc degeneration,CLA has significantly negative correlation with Pfiffmann score,and C2-7 SVA has significantly positive correlation with it.