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目的探讨青少年特发性脊柱侧凸颈椎矢状位参数手术前后变化及其与脊柱-骨盆参数的相关性,分析其改变原因及意义。方法以2011年7月-2014年7月收治并符合选择标准的35例青少年特发性脊柱侧凸患者作为研究对象,其中男12例,女23例;年龄13~20岁,平均16.2岁。Lenke分型:1型16例,2型7例,3型4例,4型3例,5型4例,6型1例。术后均获随访,随访时间5~36个月,平均10.9个月。于术前及末次随访时的脊柱全长侧位X线片测量骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、颈椎前凸角(cervical lordosis,CL)、T1倾斜角(T1 slope)、C2倾斜角(C2 slope)、C7矢状位垂直距离(C7 sagittal vertical axis,C7 SVA)、C2~7矢状位垂直距离(C2-7 plumbline,c SVA)。根据术前CL值将患者分为颈椎前凸组(CL<0°)及颈椎后凸组(CL>0°);根据颈椎后凸、前凸组术后颈椎曲度改变,对恢复前凸、后凸有改善以及前凸增大(A、B、C组)患者进行研究。采用Spearman检验分析颈椎前凸、后凸组术前CL与各参数间的相关关系。结果 35例患者手术前后PT、PI、SS、LL比较,差异有统计学意义(P<0.05);其余参数比较,差异均无统计学意义(P>0.05)。根据术前CL值,17例为颈椎前凸组,18例为颈椎后凸组。组内比较:手术前后颈椎前凸组PT、PI、SS、C2 slope、C7 SVA以及颈椎后凸组PT、PI、SS、LL、CL、TK、T1 slope、C2 slope比较,差异有统计学意义(P<0.05)。组间比较:术前两组CL、TK、C2 slope、C7SVA、T1 slope比较,差异有统计学意义(P<0.05);末次随访时两组间仅T1 slope比较差异有统计学意义(P<0.05)。术前颈椎后凸者中,术后恢复前凸7例(A组),后凸有改善7例(B组),后凸增大4例;术前颈椎前凸者中,术后前凸增大9例(C组),前凸减小3例,出现后凸5例。手术前后A组LL、CL、T1 slope、C2 slope、C7 SVA,B组TK、CL以及C组CL、c SVA比较,差异有统计学意义(P<0.05);术前颈椎后凸患者中,A、B组手术前后LL比较,差异均有统计学意义(P<0.05)。颈椎前凸组术前CL与C2 slope强烈相关(P<0.05),颈椎后凸组术前CL与C2 slope、T1 slope强烈相关、与cSVA中度相关(P<0.05)。结论颈椎在维持脊柱-骨盆矢状位平衡中具有重要作用,颈椎曲度的改变与胸椎后凸改变有一定相关性,青少年特发性脊柱侧凸矫形术中应尽可能恢复或维持颈椎前凸生理曲度。
Objective To investigate the changes of the cervical sagittal parameters of adolescent idiopathic scoliosis before and after surgery and its correlation with the spine-pelvic parameters, and analyze its causes and significance. Methods From July 2011 to July 2014, 35 adolescent idiopathic scoliosis patients who met the selection criteria were selected as the study subjects, including 12 males and 23 females, aged 13-20 years (average 16.2 years). Lenke classification: type 1 in 16 cases, type 2 in 7 cases, type 3 in 4 cases, type 4 in 3 cases, type 5 in 4 cases, type 6 in 1 case. All patients were followed up for 5-36 months with an average of 10.9 months. The pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and thoracic kyphosis were measured at the preoperative and final follow-up. Thoracic kyphosis (TK), lumbar lordosis (LL), cervical lordosis (CL), T1 slope, C2 slope, C7 sagittal C7 sagittal vertical axis (C7 SVA) and C2 ~ 7 plumbline (c SVA). According to the preoperative CL value, the patients were divided into cervical kyphosis group (CL <0 °) and cervical kyphosis group (CL> 0 °). According to the change of cervical curvature after cervical kyphosis and lordosis group, , Improved kyphosis, and increased anterior convexity (Groups A, B, C). Spearman test was used to analyze the relationship between preoperative CL and parameters of cervical lordosis and kyphosis group. Results There were significant differences in PT, PI, SS and LL between the 35 patients before and after operation (P <0.05). There was no significant difference between the other parameters (P> 0.05). According to preoperative CL value, 17 cases were cervical lordosis group and 18 cases were cervical kyphosis group. There was significant difference in PT, PI, SS, LL, CL, TK, T1 slope and C2 slope between PT, PI, SS, C2 slope, C7 SVA and cervical kyphosis before and after operation (P <0.05). There were significant differences in CL, TK, C2 slope, C7SVA and T1 slope between the two groups before surgery (P <0.05). There was a significant difference in T1 slope between the two groups at the last follow-up (P < 0.05). Among the patients with preoperative cervical kyphosis, 7 cases (group A) had anterior lumbar restoration, 7 cases had an improvement of kyphosis (group B), and 4 cases had kyphosis. In preoperative cervical lordosis, the anterior protrusion Increased in 9 cases (C group), reduced anterior convex in 3 cases, kyphosis occurred in 5 cases. There were significant differences in CL, c SVA between the two groups before and after operation (P <0.05); LL, CL, T1 slope, C2 slope, C7 SVA in group A, CL, The difference of LL before and after operation in group A and group B was statistically significant (P <0.05). Preoperative CL was positively correlated with C2 slope in cervical spine group (P <0.05). Preoperative CL was positively correlated with C2 slope and T1 slope in cervical kyphosis group and moderately correlated with cSVA (P <0.05). Conclusion The cervical spine plays an important role in maintaining the balance between the spine and the pelvis. The curvature of the cervical spine is related to the change of the thoracic kyphosis. In the adolescent idiopathic scoliosis orthopedic surgery, the cervical spondylolisthesis should be restored or maintained as much as possible Physiological curvature.