摘要
目的评价后路寰枢椎固定融合术中不同枕颈角(C_(0)~C_(2))、C_(1)~C_(2)角与术后下颈椎曲度(C_(2)~C_(7)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C_(0)~C_(2)、C_(1)~C_(2)角、C_(2)~C_(7)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C_(0)~C_(2)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C_(1)~C_(2)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C_(2)~C_(7)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C_(0)~C_(2)角<20°(10-20°)37例,≥20°(20°~28°)共计41例;C_(1)~C_(2)角<25°(10°~25°)共计37例,≥25°(25°~42°)共计41例。末次随访C_(1)~C_(2)角<25°、C_(0)~C_(2)角<20°与C_(2)~C_(7)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);C_(1)~C_(2)角≥25°、C_(0)~C_(2)角≥20°与C_(2)~C_(7)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);C_(0)~C_(2)角≥20°与C_(2)~C_(7)角之间的强相关(r=-0.872,绝对值>0.8),而C_(1)~C_(2)角≥25°与C_(2)~C_(7)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,C_(0)~C_(2)角≥20°或C_(1)~C_(2)角≥25°可能引起术后下颈椎曲度的减小,而C_(1)~C_(2)角10°~25°、C_(0)~C_(2)角10°~20°,可能更好的维持下颈椎生理性曲度,且以C_(0)~C_(2)角作为参考指标更为可靠。
Objective To evaluate the correlation between different occipitocervical angle(C_(0)~C_(2)),C_(1)~C_(2)angle and postoperative lower cervical curvature(C_(2)~C_(7)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.C_(0)~C_(2),C_(1)~C_(2)and C_(2)~C_(7)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 C_(0)~C_(2)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 C_(1)~C_(2)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 C_(2)~C_(7)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 C_(0)~C_(2)<20°(10°~20°)and 41 cases with the fixed angle≥20°(20°~28°).There were 37cases of C_(1)~C_(2)fixation angle<25°(10°~25°),and 41 cases of C_(1)~C_(2)fixation angle≥25°(25°~42°).During follow-up,there was no clear correlation between C_(1)~C_(2)angle<25°,C_(0)~C_(2)angle<20°and C_(2)~C_(7)angle(P=0.635 and 0.510,r=0.081 and 0.112).C_(1)~C_(2)angle≥25°and C_(0)~C_(2)angle≥20°were negatively correlated with C_(2)~C_(7)angle(P=0.002 and 0.000,r=-0.466 and-0.872,respectively).C_(0)~C_(2)angle fixing angle≥20°is strongly correlated with C_(2)~C_(7)angle(r=-0.872,absolute value>0.8),while C_(1)~C_(2)angle fixing angle≥25°is not closely correlated with C_(2)~C_(7)angle(r=-0.466,absolute value<0.5).Conclusion With posterior atlantoaxial fixation fusion,the fixation angle of C_(0)~C_(2)≥20°or the fixation angle of C_(1)~C_(2)≥25°may lead to the decrease of the postoperative curvature of the lower cervical spine,while the fixation angle of C_(1)~C_(2)10°~25°and the fixation angle of C_(0)~C_(2)10°~20°may better maintain the physiological curvature of the lower cervical spine.The fixed angle of C_(0)~C_(2)is more reliable.
作者
李建扬
李波
欧阳北平
罗春山
马向阳
邹小宝
陆廷盛
Li Jianyang;Li Bo;Ouyang Bingping;Luo Chunshan;Ma Xiangyang;Zou Xiaobao;Lu Tingsheng(Guizhou Medical University,Guiyang 550025,Guizhou Province,China;Department of Spine Surgery,Guizhou Orthopedics Hospital,Guiyang 550004,Guizhou Province,China;Department of Orthopedics,General Hospital of Southern Theatre Command of PLA,Guangzhou 510010,China)
出处
《中国临床解剖学杂志》
CSCD
北大核心
2023年第1期92-96,共5页
Chinese Journal of Clinical Anatomy
关键词
后路
寰枢椎
固定角度
下颈椎曲度
Posterior
Atlantoaxial
Fixed angle
Lower cervical curvature
