中国组织工程研究 ›› 2023, Vol. 27 ›› Issue (9): 1319-1324.doi: 10.12307/2023.278

• 骨与关节生物力学 bone and joint biomechanics • 上一篇    下一篇

颈椎矢状力线参数与颈椎间盘退变患者退变节段及Pfirrmann分级的关联性

曹  胜,孔令伟,徐  昆,孙志杰   

  1. 承德医学院附属医院,河北省承德市   067000
  • 收稿日期:2020-09-22 接受日期:2020-11-28 出版日期:2023-03-28 发布日期:2022-06-30
  • 通讯作者: 徐昆,硕士,副主任医师,承德医学院附属医院,河北省承德市 067000
  • 作者简介:曹胜,男,1989年生,汉族,2015年天津医科大学毕业,硕士,主治医师,主要从事骨外科学方面的研究。
  • 基金资助:
    承德市科技支撑计划项目(201904A050),项目负责人:曹胜

Correlation of cervical sagittal force line parameters with degenerative segment and Pfirrmann classification in patients with cervical intervertebral disc degeneration

Cao Sheng, Kong Lingwei, Xu Kun, Sun Zhijie   

  1. Affiliated Hospital of Chengde Medical College, Chengde 067000, Hebei Province, China
  • Received:2020-09-22 Accepted:2020-11-28 Online:2023-03-28 Published:2022-06-30
  • Contact: Xu Kun, Master, Associate chief physician, Affiliated Hospital of Chengde Medical College, Chengde 067000, Hebei Province, China
  • About author:Cao Sheng, Master, Attending physician, Affiliated Hospital of Chengde Medical College, Chengde 067000, Hebei Province, China
  • Supported by:
    Chengde Science and Technology Support Program, No. 201904A050 (to CS)

摘要:

文题释义:
颈椎间盘退变:作为颈椎退行性疾病基础病理性改变,颈椎间盘退变在X射线片上多表现为椎间高度丢失、椎间隙塌陷,严重影响患者生活质量。
颈椎矢状力线参数:包括颈椎前凸角、T1倾斜角、矢状面位移等,临床观察颈椎矢状力线参数变化,可为预防颈椎间盘退变及术后矢状位失衡发生提供依据。

背景:腰椎矢状位参数与腰椎间盘退变、腰椎矢状位平衡存在明显相关性,而有关颈椎的研究还相对缺乏。
目的:探讨颈椎矢状力线参数颈椎前凸角、T1倾斜角、矢状面位移与颈椎间盘退变患者退变节段、Pfirrmann分级的关联性及对疗效的评估价值。
方法:选择2017年7月至2019年12月承德医学院附属医院收治的80例颈椎间盘退变患者,均行颈后路微创椎管扩大成形术,根据患者术后6个月疗效分组,其中疗效良好组62例,疗效不良组18例。比较两组患者的临床资料、颈椎矢状力线参数(颈椎前凸角、T1倾斜角、矢状面位移),分析颈椎矢状力线参数与退变节段、Pfirrmann分级的相关性,采用受试者工作特征曲线评价颈椎矢状力线参数对疗效的评估价值。
结果与结论:①两组患者的退变节段、Pfirrmann分级相比,差异有显著性意义(P < 0.05);②术后1,6个月,疗效良好组患者颈椎矢状力线参数颈椎前凸角、T1倾斜角大于疗效不良组,矢状面位移小于疗效不良组,差异有显著性意义(P < 0.05);③不同退变节段、Pfirrmann分级患者颈椎矢状力线参数颈椎前凸角、T1倾斜角、矢状面位移相比,差异有显著性意义(P < 0.05);④颈椎间盘退变患者颈椎矢状力线参数颈椎前凸角、T1倾斜角与退变节段、Pfirrmann分级呈正相关关系(P < 0.05),矢状面位移与退变节段、Pfirrmann分级呈负相关关系(P < 0.05);⑤将性别、年龄、病程、体质量指数、颈椎病类型、退变节段、Pfirrmann分级、术前颈椎矢状力线参数等其他因素控制后,术后1,6个月颈椎矢状力线参数颈椎前凸角、T1倾斜角、矢状面位移仍与颈椎间盘退变患者疗效显著相关(P < 0.05);⑥颈椎前凸角、T1倾斜角、矢状面位移评估疗效的曲线下面积均较大,尤以联合评估最高,达0.815;⑦提示颈椎间盘退变患者颈椎矢状力线参数颈椎前凸角、T1倾斜角、矢状面位移与退变节段、Pfirrmann分级相关,且对疗效具有良好的评估价值,可为预防颈椎间盘退变及颈椎间盘退变患者术后发生矢状位失衡提供依据。

https://orcid.org/0000-0003-2270-8571 (曹胜)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱;骨折;内固定;数字化骨科;组织工程

关键词: 颈椎前凸角, T1倾斜角, 矢状面位移, 颈椎间盘退变, 退变节段, Pfirrmann分级

Abstract: BACKGROUND: The sagittal parameters of lumbar spine are significantly correlated with lumbar intervertebral disc degeneration and sagittal balance of lumbar spine, while the research on cervical spine is relatively lacking.
OBJECTIVE: To explore the correlation of cervical sagittal force line parameters cervical lordosis, T1 slope, and sagittal vertical axis with degenerative segment, Pfirrmann classification in cervical intervertebral disc degeneration patients and the value of therapeutic evaluation.
METHODS:  A total of 80 patients with cervical intervertebral disc degeneration in Affiliated Hospital of Chengde Medical College from July 2017 to December 2019 were selected as the study subjects, all of whom underwent minimally invasive spinal canal enlargement surgery through the posterior cervical approach. The patients were grouped according to the curative effect 6 months after the operation. Among them, there were 62 cases in the good curative effect group and 18 cases in the poor curative effect group. The clinical data, cervical sagittal force line parameters (cervical lordosis, T1 slope, and sagittal vertical axis) and cervical sagittal force line parameters of patients with different degeneration segments and Pfirrmann classification were compared between the two groups. The receiver operating characteristic curve was used to evaluate the value of the efficacy evaluation of the parameters of the cervical sagittal force line.  
RESULTS AND CONCLUSION: (1) There was a statistically significant difference in degeneration segments and Pfirrmann classification between the two groups (P < 0.05). (2) At 1 and 6 months after operation, the cervical sagittal force line parameters cervical lordosis and T1 slope of the patients in the good curative effect group were significantly higher than those in the poor curative effect group, and the sagittal vertical axis was significantly lower than that in the poor curative effect group (P < 0.05). (3) Cervical sagittal force line parameters cervical lordosis, T1 slope, and sagittal vertical axis were significantly different in patients with different degeneration segments and Pfirrmann classification (P < 0.05). (4) In cervical intervertebral disc degeneration patients, the cervical sagittal force line parameters cervical lordosis and T1 slope were positively correlated with degenerative segments and Pfirrmann classification (P < 0.05), while sagittal vertical axis was negatively correlated with degenerative segments and Pfirrmann classification (P < 0.05). (5) After controlling for sex, age, course of disease, body mass index, type of cervical spondylosis, degeneration segment, Pfirrmann classification, preoperative cervical sagittal force line parameters and other factors, the cervical sagittal force line parameters cervical lordosis, T1 slope and sagittal vertical axis were still significantly correlated with the efficacy of cervical intervertebral disc degeneration patients at 1 and 6 months after surgery (P < 0.05). (6) Cervical lordosis, T1 slope, and sagittal vertical axis all had higher area under the curve for evaluating curative effect, especially the highest in combined evaluation, reaching 0.815. (7) It is concluded that the parameters cervical lordosis, T1 slope, and sagittal vertical axis of the cervical spine sagittal force line in cervical intervertebral disc degeneration patients are related to the degenerative segment and Pfirrmann classification, and have a good therapeutic evaluation value. They can provide evidence for preventing the occurrence of cervical intervertebral disc degeneration and sagittal imbalance after surgery.

Key words: cervical lordosis, T1 slope, sagittal vertical axis, cervical intervertebral disc degeneration, degenerative segments, Pfirrmann classification

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