对成人颈椎不同椎体水平Cobb角相互关系的探讨

Study of correlation between Cobb angles ofdifferent cervical levels in adults

目的通过探讨颈椎不同节段水平Cobb角的相互关系,寻找C_(2)-C_(7)Cobb角的可替代角色。方法回顾性分析2017~2019年本院223例患者颈椎X线片影像资料,平均年龄(61.2±13.5)岁,以能够识别C 7椎体下终板的患者为研究对象,测量颈椎各节段水平Cobb角及活动度大小,包括C_(2)-C_(7)I、C_(2)-C_(7)S、C 2-C 6 I、C 2-C 6 S和C 2-C 5 I Cobb角(其中,I表示下终板,S表示上终板)。分析各水平Cobb角及颈椎活动度的差异性及相关性。结果C_(2)-C_(7)I Cobb角与C_(2)-C_(7)S Cobb角无显著差异性(P=0.195),与其余各水平Cobb角存在统计学差异;C_(2)-C_(7)I Cobb角与C_(2)-C_(7)S Cobb角存在强相关性(r=0.98),与其余各水平Cobb角也有较强相关性。C_(2)-C_(7)I水平与C_(2)-C_(7)S水平颈椎活动度无显著性差异(P=0.483),与其余各水平活动度存在显著性差异;C_(2)-C_(7)I水平颈椎活动度与C_(2)-C_(7)S水平颈椎活动度存在强相关性(r=0.97),与其余各水平活动度也有较强相关性。结论C_(2)-C_(7)S Cobb角可替代C_(2)-C_(7)I Cobb角用于颈椎曲度评估;当C 7椎体上下终板都无法识别时,C 2-C 6 I Cobb角、C 2-C 6 S Cobb角、C 2-C 5 I Cobb角也依次可用作评估颈椎曲度的近似参考。

Objective To find a new method of measurement out for the curvature of cervical alignment which could substitute the traditional C_(2)-C_(7)Cobb angle via the exploration of relationships between Cobbs on different cervical levels.Methods A retrospective analysis was performed on the X-ray imaging data of 223 patients recruited from the Outpatient and Inpatient Department in Orthopedics in our hospital from 2017 to 2019.The mean age was 61.2±13.5yr.Patients who were able to identify the inferior endplate of the C 7 vertebrae of the neck were studied,and the different Cobb angles and range of motions(ROM)on each level of cervical spine were measured,including C_(2)-C_(7)I,C_(2)-C_(7)S,C 2-C 6 I,C 2-C 6 S,and C 2-C 5 I Cobb angles(where I represented the lower endplate and S represented the upper endplate).The differences and correlations between these groups were compared and summarized statistically.Results The difference between C_(2)-C_(7)I Cobb angle and C_(2)-C_(7)S Cobb angle was not statistically significant(P=0.195)and that with other Cobb angles was significant.There was a strongest correlation between C 2-C 7 I Cobb angle and C_(2)-C_(7)S angle(r=0.98);meanwhile,the correlation between other Cobb angles and C_(2)-C_(7)I Cobb angle presented stronger relevance.In the same way,the ROMs of each segment on cervical spine displayed great distinction between C_(2)-C_(7)I and other levels apart from C_(2)-C_(7)S statistically.Besides,all ROMs of different cervical levels exhibited strong correlations,especially in the comparison of C_(2)-C_(7)I and C_(2)-C_(7)S(r=0.97).Conclusion Therefore,to evaluate curvature of cervical spine,C_(2)-C_(7)S Cobb angle could substituted C_(2)-C_(7)I Cobb angle thoroughly in clinical practice.Moreover,C 2-C 6 I Cobb angle,C 2-C 6 S Cobb angle,C 2-C 5 I Cobb angle could serve as approximate references when invisibility of C_(2)-C_(7)I in sequence occurs.