颈椎退变性疾病患者颈椎曲度与颅颈交界区曲度及韧带骨化的相关性研究  

Association between cervical curve and the cranio-cervical curve and ossification of ligaments in patients with cervical degenerative diseases

作　　者：吴炳轩[1] 刘宝戈[1] 桑大成 戎天华 肖博威 Wu Bingxuan;Liu Baoge;Sang Dacheng;Rong Tianhua;Xiao Bowei(Department of Orthopaedics,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院骨科,北京100070

出　　处：《中华骨科杂志》2023年第11期705-711,共7页Chinese Journal of Orthopaedics

基　　金：北京市自然科学基金(7222051);国家自然科学基金(82272524,81972084);高层次公共卫生技术人才建设项目培养计划(领军人才-02-05)。

摘　　要：目的探讨颈椎退变性疾病患者颈椎曲度与颅颈交界区曲度及韧带骨化的相关性。方法回顾性分析2016年1月至2020年7月在首都医科大学附属北京天坛医院骨科行颈椎X线及CT检查的458例颈椎退变性疾病患者资料,男265例、女193例,年龄(57.02±10.41)岁(范围22~87岁)。在颈椎标准侧位X线片上,依据颈椎矢状位形态将C_(2)~C_(7)整体曲度后凸或节段后凸角度>4°者纳入颈椎后凸组(进一步分为S、R及C型颈椎后凸组),将无颈椎后凸患者中节段Cobb角<-4°者纳入颈椎前凸组,Cobb角为-4°~4°者纳入颈椎曲度变直组。分别测量C_(2)~C_(7)整体曲度、C_(0)~C_(2)曲度,分析颈椎曲度与颅颈交界区曲度参数的关系。采用颈椎CT识别颈椎及颅颈交界区韧带骨化,包括后纵韧带骨化、项韧带骨化、黄韧带骨化、横韧带骨化、齿突尖韧带骨化、弥漫性特发性骨质增生症(diffuse idiopathic skeletal hyperostosis,DISH)及齿突加帽征(capped dens sign,CDS),分析颈椎曲度与韧带骨化的关系。将颈椎正中矢状面CT骨化结构长度占寰椎前弓后上缘至枕骨大孔前下缘之间距离超过2/3定义为3度CDS。结果颈椎前凸组245例、颈椎曲度变直组114例、S型颈椎后凸组53例、R型颈椎后凸组36例、C型颈椎后凸组10例。所有患者中,C_(2)~C_(7)整体曲度与C_(0)~C_(2)曲度呈负相关(r=-0.45,P<0.001)。R型颈椎后凸组患者C_(2)~C_(7)整体曲度与C_(0)~C_(2)曲度呈负相关(r=-0.58,P<0.001),颈椎前凸组(r=-0.10,P=0.124)、颈椎曲度变直组(r=-0.11,P=0.233)、S型颈椎后凸组(r=-0.01,P=0.943)、C型颈椎后凸组(r=0.03,P=0.946)患者的C_(2)~C_(7)整体曲度与C_(0)~C_(2)曲度均无相关性。CDS的发生率为38.4%(176/458),其中3度CDS发生率为17.9%(82/458)。R型退变性颈椎后凸与3度CDS的发生相关(r=0.10,P=0.030)。所有颈椎后凸、S型颈椎后凸、C型颈椎后凸、C_(2)~C_(7)整体曲度、C_(0)~C_(2)曲度与颈椎后纵韧带骨化、项韧�Objective To explore the correlation between cervical curve and ossification of ligaments in cranio-cervical junction and cervical spine in patients with cervical degenerative diseases.Methods A retrospective study was conducted among 458 patients with cervical degenerative disease who underwent cervical spine X-ray and CT examinations at the Orthopedics Department of Beijing Tiantan Hospital,Capital Medical University between January 2016 and July 2020.There were 265 males and 193 females,with an average age of 57.02±10.41 years(range,22-87 years).Patients were divided into 5 types(lordosis,straight,S-type degenerative kyphosis,R-type degenerative kyphosis and C-type degenerative kyphosis).Cervical lordosis was defined as C_(2)-C_(7) curve<-4°,cervical kyphosis was defined as>4°,cervical straight was defined as-4°to 4°.C_(2)-C_(7) curve,C_(0)-C_(2) curve were measured respectively,and correlations among these imaging parameters were analyzed.CT images were used to assess the presence of ossification of ligaments in cranio-cervical and cervical spine,including ossification of the posterior longitudinal ligament,nuchal ligament,ligamentum flavum,transverse ligament,apical ligament,diffuse idiopathic skeletal hyperostosis(DISH),as well as capped dens sign(CDS),and correlations between these cervical curve and presence of ossification of ligaments were analyzed.The different grades were based on the length of the ossification of interest with respect to the distance from the posterosuperior rim of the anterior arch of the atlas to the inferior margin of the foramen magnum on mid-sagittal cervical spine CT images,Grade 3 CDS was determined when the length was more than two-thirds.Results There were 245 patients with cervical lordosis,114 patients with straight,53 patients with S-type degenerative cervical kyphosis,36 patients with R-type degenerative cervical kyphosis and 10 patients with C-type degenerative cervical kyphosis.C_(0)-C_(2) curve showed a negative correlation with C_(2)-C_(7) curve in all enrolled

关 键 词：颈椎 脊柱后凸 椎间盘退行性变 韧带 骨化 异位性 

分 类 号：R681.5[医药卫生—骨科学]