青少年特发性脊柱侧凸患者颈椎矢状位曲度变化及影响因素分析
王连雷,刘新宇,原所茂,田永昊,郑燕平,李建民,周超,张玉玲
中国临床解剖学杂志 ›› 2015, Vol. 33 ›› Issue (6) : 712-716.
青少年特发性脊柱侧凸患者颈椎矢状位曲度变化及影响因素分析
Analysis of the change and influencing factors of cervical sagittal curvature in adolescent idiopathic scoliosis patients
目的 总结48例青少年特发性脊柱侧凸（AIS）患者的影像学资料，分析AIS侧凸患者颈椎矢状位曲度变化特点及其影响因素。 方法 AIS患者拍摄站立位脊柱全长正侧位X片以及左右侧屈位片（Bending相）。测量并记录中立位及左右Bending相冠状位Cobb角、颈椎矢状位曲度（C2~7 Cobb角）、胸椎后凸角（T5~12 Cobb角, TK）、腰椎前凸角（L1~5 Cobb角, LL）、骨盆入射角(Pelvic Incidence，PI)、骶骨倾斜角(Sacrum Slop，SS)、骨盆倾斜角(Pelvic Tilt，PT)、C7~S1 及C2~7 SVA (Sagittal Vertical Axis)。26例健康青少年志愿者拍摄脊柱全长正侧位片，记录C2~7 Cobb角。应用两变量相关性分析及t检验作为主要统计方法。 结果 AIS患者颈椎矢状位曲度异常发生率75.0%，后凸发生率47.9%，失平衡发生率10.4%，失平衡者均合并颈椎后凸。AIS患者PI-LL<10°者占所有AIS患者的62.5%。AIS患者与健康青少年相比，C2~7 Cobb角显著性增大（P=0.008）。AIS患者中颈椎后凸组，T5-12 Cobb角显著降低（P =0.011）。胸椎后凸角度<30°组C2~7 Cobb角显著增大（P=0.021）。C2~7 Cobb角与T5~12 Cobb角成负相关(P =0.009），与L1~5 Cobb角成正相关（P=0.005）。C2~7 Cobb角与冠状位Cobb角度、PI、SS、PT、C7~S1 SVA及Lenke分型未见相关性（P＞0.05）。 结论 AIS患者颈椎矢状位曲度异常者比例高于正常青少年，且多为后凸型。颈椎矢状位曲度与胸椎后凸角度、腰椎前凸角度相关，而与胸腰椎冠状位角度及骨盆指数无关。
Objective Summarize the radiographic data of 48 patients with adolescent idiopathic scoliosis (AIS) to analyze the characteristics and influencing factors of cervical sagittal alignment in AIS patients. Methods For AIS patients, The angle of the main thoracic curve (TC), the proximal thoracic curve (PTC), the thoracolumbar curve (TLC), and the lumbar curve (LC), C2~7 Cobb angle, T5~12 Cobb angle, L1~5 Cobb angle, pelvic incidence (PI), pelvic tilt (PT), sacrum slop (SS), C2~7 sagittal vertical axis (C2~7 SVA), C7~S1 sagittal vertical axis (C7~S1 SVA) were included in radiographic measurements. In addition, the C2~7 Cobb angle was measured for the young volunteers. Lenke classification was used for AIS curve type classification. Pearson correlation coefficients and T-test were used for statistical analysis. Results The incidence of cervical deformity,cervical kyphosis and cervical imbalance was 75.0%, 47.9 and 10.4% respectively. The C2~7 Cobb angle of AIS patients significantly increased than the volunteers (P=0.008). In the cervical kyphosis group, T5~12 Cobb angle was significantly lower than that of the normal group (P=0.011). The C2~7 Cobb angle of the T5~12 Cobb angle＞30°group increased significantly than the T5~12 Cobb angle≤30°group(P=0.021).The C2~7 Cobb angle was significantly correlated with T5~12 Cobb angle (P=0.009) and L1~5 Cobb angle(P=0.005). There was no significant relevance between C2~7 Cobb angle and TC，PTC，TLC，LC，Lenke Curve Type，PI，PT，SS，C7~S1 SVA（P＞0.05). Conclusion The cervical sagittal alignment is only related with TK and LL, especially with TK. It has no relationship with Lenke curve type, coronal angle of thoracic and lumbar spine, and pelvic parameters(PI，PT，SS).
/ 青少年特发性脊柱侧凸 / 颈椎曲度 / 矢状位平衡
Adolescent Idiopathic Scoliosis / Cervical Curvature / Sagittal Alignment
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