中国组织工程研究

中国组织工程研究 ›› 2025, Vol. 29 ›› Issue (33): 7196-7202.doi: 10.12307/2025.755

• 骨科植入物相关临床实践 Clinical practice of orthopedic implant • 上一篇    下一篇

腰椎退行性侧弯矫正后颈椎和胸椎的代偿性对齐变化

曹  勇，李  信，陈志刚，顾红林，吕书军   

  1. 海安市人民医院(南通大学附属海安医院)，江苏省南通市  226600
  • 收稿日期:2024-05-23 接受日期:2024-08-05 出版日期:2025-11-28 发布日期:2025-04-12
  • 通讯作者: 吕书军，主任医师，海安市人民医院(南通大学附属海安医院)，江苏省南通市 226600
  • 作者简介:曹勇，男，1976年生，江苏省东台市人，汉族，2009年南通大学毕业，硕士，副主任医师，主要从事脊柱退行性疾病、畸形的临床和基础研究。

Compensatory alignment changes of cervical and thoracic spine after correction of lumbar degenerative scoliosis

Cao Yong, Li Xin, Chen Zhigang, Gu Honglin, Lyu Shujun   

  1. Hai’an People’s Hospital (Hai’an Hospital Affiliated to Nantong University), Nantong 226600, Jiangsu Province, China
  • Received:2024-05-23 Accepted:2024-08-05 Online:2025-11-28 Published:2025-04-12
  • Contact: Lyu Shujun, Chief physician, Hai’an People’s Hospital (Hai’an Hospital Affiliated to Nantong University), Nantong 226600, Jiangsu Province, China
  • About author:Cao Yong, MS, Associate chief physician, Hai’an People’s Hospital (Hai’an Hospital Affiliated to Nantong University), Nantong 226600, Jiangsu Province, China

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摘要：


文题释义：

退变性腰椎侧弯：由于退变因素不断累积而导致腰椎冠状面 Cobb角> 10°的脊柱三维结构畸形。
脊柱代偿性变化：描述相邻脊柱未融合区域在术后出现的动态变化，这些变化凸显了脊柱具有自身的适应性机制，通过全局矢状面重新对齐和矫正来帮助维持水平视线。


背景：目前关于腰椎退变性侧弯患者矫形术后颈胸椎矢状面参数的代偿性改变及其内在联系，以及上述改变对生活质量的影响，尚缺乏相关研究。

目的：评估腰椎退行性侧弯矫正术后颈椎和胸椎的代偿性对齐变化。
方法：纳入接受腰椎退行性侧弯矫正治疗的患者103例，评估患者的人口统计学特征和脊柱矢状面参数，并尝试建立颈椎矢状面参数变化与腰椎畸形矫正后的预测方程。同时，采用SRS-22量表评估患者的生活质量，探究矫正术后颈椎和胸椎代偿性变化与患者健康相关生活质量之间的关系。

结果与结论：①术后3个月及2年，颈椎、胸椎各指标与术前相比均显著改善(P < 0.05)，但术后3个月与术后2年相比变化不显著(P > 0.05)；术后3个月及2年，腰椎参数中腰椎前凸角、C7-S1矢状面垂直轴、骨盆入射角-腰椎前凸角与术前相比有显著变化(P < 0.05)，但术后3个月与术后2年相比变化不显著(P > 0.05)；②相关性分析显示，腰椎前凸角与C3-C7颈椎前凸角、C1-C7颈椎前凸角、C2-7矢状面垂直轴、胸廓入口角和C7-S1矢状面垂直轴高度相关(|r|≥0.5，P < 0.000 1)；腰椎前凸角与胸椎后凸角也有显著的相关性(r=-0.280)；③建立了2个颈椎代偿性变化的预测公式：颈椎前凸角=0.524×腰椎前凸角-6.612，C2-7矢状面垂直轴=-0.263×腰椎前凸角-5.436(P < 0.05，R2 > 0.6)；④术后C2-7 矢状面垂直轴在14.4-26.8 mm之间，颈椎前凸角在9°-41°之间，腰椎前凸角在42.7°-68.7°之间，矢状面垂直轴在-40-40 mm之间的患者，生活质量恢复更好；⑤提示腰椎退行性侧弯矫正术后可以观察到显著的颈椎矢状面代偿性变化，发现腰椎前凸每增加1°，颈椎前凸相应增加约0.5°，C2-7 矢状面垂直轴相应减少约0.3 mm；如果代偿性变化更接近于正常矢状面，患者满意度更高。

https://orcid.org/0009-0000-0512-4107(曹勇)

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: 颈椎对齐, 退行性腰椎侧弯, 适应性改变, 预测方程, 健康相关生活质量, 脊柱矢状面参数, 骨科植入物

Abstract: BACKGROUND: Compensatory changes in sagittal parameters of the cervicothoracic spine after orthopedic surgery in patients with lumbar degenerative scoliosis and their intrinsic relationship, as well as the impact of these changes on quality of life, are still lacking. 
OBJECTIVE: To evaluate the compensatory alignment of cervical and thoracic vertebrae after correction of lumbar degenerative scoliosis. 
METHODS: 103 patients who underwent surgical correction of lumbar degenerative scoliosis were included in this study. Patients’ demographic characteristics and spinal sagittal parameters were assessed, and prediction equations between changes in cervical sagittal parameters and lumbar deformity correction were attempted. Simultaneously, the SRS-22 scale was used to assess the quality of life of patients and to explore the relationship between the compensatory changes of the cervical and thoracic spine after correction and the patients’ health-related quality of life.  
RESULTS AND CONCLUSION: (1) At 3 months and 2 years after surgery, all indicators of the cervical spine and thoracic spine were significantly improved compared with those before surgery (P < 0.05), but there was no significant change at 3 months after surgery compared with 2 years after surgery (P > 0.05). At 3 months and 2 years after surgery, the lumbar spine parameters including lumbar lordosis, C7-S1 sagittal vertical axis, and pelvic incident-lumbar lordosis had significant changes compared with those before surgery (P < 0.05), but the change was not significant at 3 months after surgery compared with 2 years after surgery (P > 0.05). (2) Correlation analysis showed that the lumbar lordosis was highly correlated with the C3-C7 cervical lordosis, C1-C7 cervical lordosis, C2-7 sagittal vertical axis, thoracic inlet angle, and C7-S1 sagittal vertical axis (|r| ≥ 0.5, P < 0.000 1). The lumbar lordosis was correlated with the thoracic kyphosis (r=-0.280). (3) Two prediction formulas were established for compensatory changes in cervical spine: cervical lordosis=0.524×, lumbar lordosis=-6.612, C2-7 sagittal vertical axis=-0.263×, and lumbar lordosis=-5.436 (P < 0.05, R2 > 0.6). (4) When postoperative C2-7 sagittal vertical axis was between 14.4 and 26.8 mm; cervical lordosis was between 9° and 41°, lumbar lordosis was between 42.7° and 68.7°, and sagittal vertical axis was between -40 and 40 mm, patients had better quality of life recovery. (5) It is indicated that significant compensatory changes in the sagittal plane of the cervical spine can be observed after correction of lumbar degenerative scoliosis. We found that each 1° increase in lumbar lordosis was associated with a corresponding increase of about 0.5° in cervical lordosis and a corresponding decrease of about 0.3 mm in the vertical axis of the C2–7 sagittal plane. Patient satisfaction was higher if compensatory changes were closer to normal sagittal plane. 

Key words: cervical alignment, degenerative lumbar scoliosis, adaptive change, predictive equation, health-related quality of life, sagittal parameters of spine, orthopedic implants

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