C_(7)倾斜角与脊柱整体矢状面平衡的相关性  

Correlation between C_(7)slope and overall sagittal balance of spine

作　　者：刘承鑫 史彬 李翔宇 孙康 鲁世保[1] Liu Chengxin;Shi Bin;Li Xiangyu;Sun Kang;Lu Shibao(Department of Orthopaedics,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院骨科,北京100053

出　　处：《脊柱外科杂志》2022年第6期404-409,共6页Journal of Spinal Surgery

摘　　要：目的探讨腰背痛患者C_(7)倾斜角(C_(7)S)与脊柱矢状面参数、脊柱矢状面平衡状态之间的关系。方法对215例腰背痛患者进行回顾性研究,在术前、术后脊柱全长X线片上测量脊柱矢状面参数,并引入颈胸组合参数“颈椎前凸角(CL)/C_(7)S”。根据患者术前矢状面平衡状态(矢状面轴向距离,SVA)和胸椎代偿能力(胸椎后凸角,TK)将患者分为3类。类型A,脊柱矢状面平衡(SVA≤5 cm);类型B,脊柱矢状面失平衡,胸椎具有代偿能力(SVA>5 cm,TK≤40°);类型C,脊柱矢状面失平衡,胸椎失代偿(SVA>5 cm,TK>40°)。分析C_(7)S与脊柱矢状面参数之间的相关性,比较3类患者脊柱矢状面参数的差异。结果C_(7)S与T_(1)倾斜角(T_(1)S)、TK、CL、颈椎SVA(cSVA)、SVA及患者年龄之间均存在相关性(r=0.305~0.802,P<0.05)。C7S的变化与TK的变化有关(r=0.494,P<0.05),与SVA及CL的变化均无关。相比于类型A,类型B患者的SVA、CL和CL/C_(7)S更大,TK更小,差异均有统计学意义(P<0.05),cSVA、C_(7)S差异无统计学意义(P>0.05);相比于类型A,类型C患者的cSVA、SVA、CL、TK、C_(7)S和CL/C_(7)S更大,差异均有统计学意义(P<0.05);相比于类型B,类型C患者的cSVA、C_(7)S、CL和TK更大,差异均有统计学意义(P<0.05),但CL/C_(7)S和SVA差异无统计学意义(P>0.05)。CL/C_(7)S评价脊柱矢状面平衡的临界值为0.618。结论C_(7)S与脊柱矢状面参数之间存在较好相关性。当CL/C_(7)S>0.618时,脊柱更多处于失平衡状态。Objective To investigate the relationship between C_(7)slope(C_(7)S),the sagittal parameters of spine,and the sagittal balance of the spine in the patients with low back pain.Methods A retrospective study was conducted on 215 patients who were hospitalized due to low back pain.The sagittal parameters of the spine were measured on the whole spine roentgenograph before and after operation.The combination parameter“cervical lordosis(CL)/C_(7)S”was introduced.According to the preoperative sagittal balance of the spine(sagittal vertical axis,SVA)and the compensatory ability of the thoracic spine(thoracic kyphosis,TK),patients were divided into 3 types:type A,sagittal balance(SVA≤5 cm);type B,sagittal imbalance but the thoracic spine had compensatory ability(SVA>5 cm,TK≤40°);type C,sagittal imbalance and the thoracic spinal decompensation(SVA>5 cm,TK>40°).The correlation between C_(7)S and the sagittal parameters of the spine was analyzed,and the differences in spine sagittal parameters between the 3 types patients were compared.Results There was a significant correlation between C_(7)S and T_(1) slope(T_(1)S),TK,CL,cervical SVA(cSVA),SVA and age(r=0.305-0.802,P<0.05).The change of C_(7)S was related to the change of TK(r=0.494,P<0.05),and was not related to the changes of SVA and CL.Compared with type A,type B had greater SVA,CL and CL/C_(7)S,smaller TK,all with a statistical significance(P<0.05),and there was no significant difference in C_(7)S and cSVA(P>0.05).Compared with type A,type C had greater cSVA,SVA,CL,TK,C_(7)S,and CL/C_(7)S,all with a statistical significance(P<0.05).Compared with type B,type C had greater cSVA,C_(7)S,CL and TK,all with a statistical significance(P<0.05),but there was no significant difference between SVA and CL/C_(7)S(P>0.05).The critical value of CL/C_(7)S to evaluate the sagittal balance of the whole spine was 0.618.Conclusions There is a good correlation between C_(7)S and the sagittal parameters of the spine.When CL/C_(7)S>0.618,the spine is more in an unbalanced state.

关 键 词：颈椎 胸椎 腰痛 肌肉骨骼平衡 摄影测量法 

分 类 号：R687.3[医药卫生—骨科学]