目的 评价后路寰枢椎固定融合术中不同枕颈角（C0~C2）、C1~C2角与术后下颈椎曲度（C2~C7角）之间的相关性，探索最佳的寰枢椎固定角度并评估两种指标对下颈椎曲度影响的可靠性，为临床治疗提供理论依据。 方法 对 2016年1月至 2018年6月对上颈椎疾病行后路寰枢椎固定融合术中78例患者进行术后随访。分别测量术前及末次随访颈椎侧位片C0~C2、C1~C2角、C2~C7角，前凸为“+”值， 后凸为“-”值，并观察夹角之间的相关性。 结果 所有患者均获得随访，时间12~18月，平均16月，术前及末次随访时C0~C2角平均值分别为 (11.87±1.36)°、(20.14±5.20)°， 差异有统计学意义(t=-14.635， P<0.001)；术前及末次随访时C1~C2角平均值分别为 (15.55±1.70)°、(26.67±7.70)°，差异有统计学意义(t=-12.748，P<0.001) ；术前及末次随访时 C2~C7 角平均值分别为(18.16±2.81)°、(13.05±6.27)°差异有统计学意义(t=7.500，P值0.000)；其中末次随访C0~C2角 < 20°（10-20°）37例， ≥20°(20°~28°)共计41例；C1~C2角 < 25° (10°~25°)共计 37例， ≥25°(25°~42°)共计 41例。末次随访 C1~C2角 < 25°、C0~C2角 < 20°与 C2~C7 角之间无明确的相关性（P值分别为0.635和0.510,r值分别为0.081和0.112）；C1~C2角 ≥25°、C0~C2角≥20°与 C2~C7 角之间存在线性负相关（P值分别为0.002和0.000，r值分别为-0.466和-0.872）；C0~C2角 ≥20°与C2~C7 角之间的强相关（r= -0.872，绝对值＞0.8），而C1~C2角 ≥25°与C2~C7 角之间的弱相关（r= -0.466，绝对值<0.5）。 结论 后路寰枢椎固定融合术中，C0~C2角 ≥20°或C1~C2角 ≥25°可能引起术后下颈椎曲度的减小，而C1~C2角10°~25°、C0~C2角10°~20°，可能更好的维持下颈椎生理性曲度，且以C0~C2角作为参考指标更为可靠。
Abstract
Objective To evaluate the correlation between different occipitocervical angle (C0~C2), C1~C2 angle and postoperative lower cervical curvature (C2~C7 angle) after posterior atlantoaxial fixation fusion, and to explore the best angle of atlantoaxial fixation and assess the reliability of the influence of these two indexes on the lower cervical curvature, so as to provide theoretical basis for clinical treatment. Methods From January 2016 to June 2018, 78 patients with disorders of the upper cervical spine who underwent posterior atlantoaxial fixation fusion were followed up. C0~C2, C1~C2 and C2~C7 angles on lateral radiographs of cervical spine were measured respectively. Lordosis was "+" value, kyphosis was "-" value, and the correlation between the included angles was observed. Results All patients were followed up for 12 to 18 months, with an average of 16 months. The mean C0~C2 angles during preoperative and postoperative follow-up were (11.87±1.36)°and (20.14±5.20)°, respectively, with statistically significant differences (t=-14.635, P<0.001). The mean C1~C2 angles during preoperative and postoperative follow-up were (15.55±1.70)° and (26.67±7.70)°, respectively, the difference was statistically significant (t=-12.748, P<0.001). The mean C2~C7 angle during preoperative and postoperative follow-up were (18.16±2.81)° and (13.05±6.27)°, respectively, with statistical significance (t=7.500, P<0.001). The postoperative follow-up included 37 cases with the fixed angle of C0~C2 <20° (10°~20°) and 41 cases with the fixed angle ≥20°(20°~28°). There were 37 cases of C1~C2 fixation angle <25°(10°~25°), and 41 cases of C1~C2 fixation angle ≥25°(25°~42°). During follow-up, there was no clear correlation between C1~C2 angle <25°, C0~C2 angle <20° and C2~C7 angle (P=0.635 and 0.510, r=0.081 and 0.112). C1~C2 angle ≥25° and C0~C2 angle ≥20° were negatively correlated with C2~C7 angle (P=0.002 and 0.000, r=-0.466 and -0.872, respectively). C0~C2 angle fixing angle ≥20° is strongly correlated with C2~C7 angle (r=-0.872, absolute value > 0.8), while C1~C2 angle fixing angle ≥25° is not closely correlated with C2~C7 angle (r=-0.466, absolute value<0.5). Conclusion With posterior atlantoaxial fixation fusion, the fixation angle of C0~C2 ≥20° or the fixation angle of C1~C2 ≥25° may lead to the decrease of the postoperative curvature of the lower cervical spine, while the fixation angle of C1~C210°~25° and the fixation angle of C0~C2 10°~20° may better maintain the physiological curvature of the lower cervical spine. The fixed angle of C0~C2 is more reliable.
关键词
后路 /
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寰枢椎 /
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固定角度 /
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下颈椎曲度
Key words
Posterior /
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Atlantoaxial /
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Fixed angle /
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Lower cervical curvature
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