基于真实世界非特异性颈痛与颈椎矢状位参数的相关性分析  

Relationship between non-specific neck pain and cervical sagittal parameters based on a real world study

作　　者：苏楠[1] 费琦[1] 李锦军[1] 孟海[1] 杨雍[1] Su Nan;Fei Qi;Li Jinjun;Meng Hai;Yang Yong(Department of Orthopedics,Bejing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《国际外科学杂志》2025年第3期169-175,F0003,共8页International Journal of Surgery

基　　金：首都医科大学附属北京友谊医院科研启动基金(YYQDKT2020-26)。

摘　　要：目的:本研究拟通过真实世界数据,分析非特异性颈痛(NNP)患者中颈痛严重程度和持续时间与颈椎矢状位各参数之间的相关性,初步探讨NNP与颈椎矢状位序列间的关系。方法:回顾性分析2023年1—9月在首都医科大学附属北京友谊医院门诊就诊的且主诉为颈痛的126例患者的病例资料。其中男性42例,女性84例;年龄15~76岁,平均(42.21±14.88)岁。根据患者颈痛持续时间是否超过3个月分为急性颈痛组(n=57)和慢性颈痛组(n=69);根据患者颈痛严重程度分为轻度颈痛组(n=72)和中重度颈痛组(n=54)。记录每例患者颈痛的持续时间和颈痛视觉模拟评分(VAS)。通过颈椎侧位X线测量患者的颈椎矢状位相关参数,包括颈椎前凸角(CL,即C_(2)~C_(7) Cobb′角)、颈椎矢状面轴向距离(cSVA)、T_(1)倾斜角(TS),并计算T_(1)倾斜角与颈椎前凸角的差值(TS-CL)。同时通过颈椎侧位X线记录患者是否存在颈椎后凸畸形,以及是否合并项韧带骨化(ONL)。颈痛VAS评分以中位数(四分位间距)[M(Q_(1),Q_(3))]表示。正态分布的计量资料以均数±标准差(±s)表示,组间比较采用t检验;计数资料以例数和百分比[例(%)]表示,组间比较采用χ^(2)检验。采用Spearman相关性分析探讨颈痛VAS评分和持续时间与患者年龄、性别、影像学相关参数(CL、cSVA、TS、TS-CL)的相关性,以及与患者颈椎后凸畸形、ONL发生的相关性。结果:所有患者颈痛VAS评分中位数为4(3,5)分。对所有患者而言,颈痛VAS评分与cSVA(P=0.029)及TS-CL值(P=0.028)显著相关,而与CL(P=0.235)、TS(P=0.355)、是否出现颈椎后凸畸形(P=0.988)、是否合并ONL(P=0.181)无明显相关性。急性颈痛组和慢性颈痛组患者的TS-CL值分别为(11.80±8.38)°和(8.77±7.61)°,差异具有统计学意义(P=0.035),而cSVA、CL、TS、ONL发生率、颈椎后凸畸形发生率两组间差异无统计学意义(P>0.05)。患者轻度颈痛组和中重度颈痛组患者的cSVA分别Objective:To analyze the relationship between neck pain severity and duration and cervical sagittal parameters in non-specific neck pain(NNP)patients from a real world data,and to initially explore the relationship between NNP and cervical sagittal position sequence.Methods:The clinical data of 126 patients with main complaint of neck pain in the outpatient department of Beijing Friendship Hospital,Capital Medical University from January to September 2023 were retrospectively analyzed.This cohort included 84 female and 42 male patients with a mean age of(42.21±14.88)years(aged from 15 to 76 years).According to the duration of neck pain was more than 3 month or not,patients were divided into acute neck pain group(n=57)and chronic neck pain group(n=69).Patients were divided into mild neck pain group(n=72)and moderate and severe neck pain group(n=54)according to the severity of neck pain.The duration and visual analogue scale(VAS)of neck pain for each patient was recorded.Cervical sagittal related parameters,including cervical lordosis(C_(2)-C_(7) Cobb′angle,CL),C_(2)-C_(7) sagittal vertical axis(cSVA),T_(1) slope(TS)were measured by cervical lateral X-ray,and the value of T_(1) slope minus cervical lordosis(TS-CL)was calculated.At the same time,cervical lateral X-ray was used to record whether the patient had cervical kyphosis and whether the patient was associated with ossification of the nuchal ligament(ONL).The VAS score of neck pain was expressed as the median(interquartile)[M(Q_(1),Q_(3))].Measurement data with normal distribution were represented as mean±standard deviation(±s),and the comparison between groups was conducted using the t-test;the comparison of count data were represented as cases and percentage,and was conducted by Chi-square test.Spearman correlation analysis was used to investigate the correlation of VAS score and duration of neck pain with age,gender,imaging parameters(CL,cSVA,TS,TS-CL),cervical kyphosis and ONL.Results:The median VAS score of all patients with neck pain was 4(3,5).For

关 键 词：颈痛 颈椎 颈椎前凸角 非特异性颈痛 T_(1)倾斜角 

分 类 号：R681.5[医药卫生—骨科学]