断层融合技术在评估年龄与颈椎矢状位序列关系中的应用

Application of digital tomosynthesis for the evaluation between age and cervical sagittal alignment

目的对比分析不同年龄组无症状正常人的颈椎侧位断层融合(DTS)图像上颈椎矢状位参数,探讨年龄因素对于颈椎矢状位曲度的影响。方法自2018年1月至2019年1月从郑州大学第一附属医院门诊招募120名健康的志愿者(男62名,女58名),将志愿者依据年龄划分为4组,A组≤20岁;B组:21~40岁;C组:41~60岁;D组≥61岁,每组包括30名研究对象。在颈椎侧位X线断层融合图像上分别测量T1倾斜角(T1S)、胸廓入口角(TIA)、颈倾斜角(NT)、C2~C7 Cobb角(Cobb C2~7)以及C2~C7矢状位轴(C2~7 SVA),利用单因素方差分析比较不同年龄组之间各参数是否存在差异,并分析年龄与颈椎矢状位参数变化的相关性。结果 A、B、C、D各组的Cobb C2~7均值分别为(19.23±8.20)°、(20.13±7.39)°、(14.34±6.26)°、(14.41±7.49)°,C2~7 SVA均值分别为(12.34±4.31)、(14.45±4.45)、(17.17±5.63)、(18.43±6.45) mm,T1S均值分别为(30.09±6.26)°、(29.06±6.18)°、(23.71±4.88)°、(21.38±5.71)°,NT均值分别为(41.95±8.88)°、(43.05±8.76)°、(45.89±8.20)°、(48.64±8.39)°,组间差异有统计学意义(F=5.265、8.053、15.766、3.684,P<0.05),A、B、C、D各组的TIA均值分别为(72.04±7.76)°、(72.11±6.98)°、(69.60±8.75)°、(70.01±8.73)°,组间差异无统计学意义(F=0.495,P>0.05);Cobb C2~7、T1S与年龄呈负相关(r=-0.450,P<0.05、r=-0.525,P<0.05);NT、C2~7 SVA与年龄呈正相关(r=0.303,P<0.05、r=0.406,P<0.05)。结论颈椎矢状位曲度在不同年龄段之间差异有统计学意义,40岁左右人群的颈椎前凸程度随年龄增长开始显著减小。因此,年龄增长可引起颈椎曲度变直。

Objective To compare and analyze sagittal parameters of cervical spine on digital tomosynthesis(DTS)images in normal population of different age groups,and explore whether age affects cervical sagittal curvature.Methods A total of 120 healthy volunteers(including 62 males and 58 females)who visited the outpatient department from January of 2018 to January of 2019 in the First Affiliated Hospital of Zhengzhou University were selected.Based on age,all the study subjects were divided into 4 groups(n=30 for each group),group A:≤20 years old,group B:21-40 years old,group C:41-60 years old,group D:≥61 years of age.Parameters included T1-slope(T1S),thoracic inlet angle(TIA),neck tilt(NT),C2-C7 Cobb angle(Cobb C2-7)and C2-C7 sagittal vertical axis(C2-7 SVA)were measured on lateral digital tomosynthesis images of cervical spine,to determine whether the parameters were different in different age groups,and to analyze the correlation between cervical sagittal parameters and age.Results The mean values of Cobb C2-7 in groups A,B,C and D were(19.23±8.20)°,(20.13±7.39)°,(14.34±6.26)°and(14.41±7.49)°,respectively.The mean values of C2-7 SVA in groups A,B,C and D were(12.34±4.31)mm,(14.45±4.45)mm,(17.17±5.63)mm and(18.43±6.45)mm,respectively.The mean values of T1S in groups A,B,C and D were(30.09±6.26)°,(29.06±6.18)°,(23.71±4.88)°and(21.38±5.71)°,respectively.The mean values of NT in groups A,B,C and D were(41.95±8.88)°,(43.05±8.76)°,(45.89±8.20)°and(48.64±8.39)°,respectively.There were significant differences in Cobb C2-7,C2-7 SVA,T1S and NT among different age groups(F=5.265,8.053,15.766,3.684,P<0.05).The mean values of TIA in groups A,B,C and D were(72.04±7.76)°,(72.11±6.98)°,(69.60±8.75)°and(70.01±8.73)°,respectively.There was no significant difference in TIA among different age groups(F=0.495,P>0.05).Cobb C2-7 and T1S had negative correlations with age respectively(r=-0.450,P<0.05;r=-0.525,P<0.05).However,NT and C2-7 SVA had positive correlations with age respectively(r=0.303,P<0.05;r=0.406,P<0.05).Conclusion There are significant differences in sagittal alignment of cervical spine among different age groups.The lordosis of the cervical spine is significantly reduced with age in people at about 40 years old.Increase of age is likely to be an important factor leading to straightalization of cervical spine.