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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (4): 712-718. doi: 10.19723/j.issn.1671-167X.2022.04.021

• 论著 • 上一篇    下一篇

无症状中国年轻人颈椎矢状位曲度正常值及其与全脊柱平衡的关系

唐彦超1,赵文奎2,于淼1,刘晓光1,*()   

  1. 1. 北京大学第三医院骨科，北京 100191
    2. 北京大学第三医院疼痛科，北京 100191
  • 收稿日期:2021-05-25 出版日期:2022-08-18 发布日期:2022-08-11
  • 通讯作者: 刘晓光 E-mail:xglius@vip.sina.com
  • 基金资助:
    国家自然科学基金面上项目(81972103)

Normative values of cervical sagittal alignment according to the whole spine balance: Based on 126 asymptomatic Chinese young adults

Yan-chao TANG1,Wen-kui ZHAO2,Miao YU1,Xiao-guang LIU1,*()   

  1. 1. Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
    2. Pain Medicine Center, Peking University Third Hospital, Beijing 100191, China
  • Received:2021-05-25 Online:2022-08-18 Published:2022-08-11
  • Contact: Xiao-guang LIU E-mail:xglius@vip.sina.com
  • Supported by:
    General Program of the National Natural Science Foundation of China(81972103)

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摘要：

目的: 探讨无症状中国年轻人颈椎矢状位曲度的正常值及其与全脊柱平衡的关系。方法: 2011年11月—2014年12月招募并选择年龄18~30岁的志愿者行全脊柱侧位X线检查，在X线片上测量指标包括C0-C2角、从C2-C3到C6-C7的间盘角、从C3到C7的椎体角、T1倾斜角、胸椎后凸角(thoracic kyphosis, TK)、腰椎前凸角(lumbar lordosis, LL)、骨盆入射角(pelvic incidence, PI)、骶骨倾斜角(sacral slope, SS)、C2-C7矢状轴向垂线(C2-C7 sagittal vertical axis, C2-C7SVA)、头重心至C7的矢状位轴向垂线(center of gravity of head to C7SVA, CGH-C7SVA)、C7到S1的矢状位轴向垂线(C7-S1SVA)。依据脊柱骨盆矢状位形态进行Roussouly分型，比较不同Roussouly分型下的颈椎曲度及形态。结果: 共纳入126名志愿者参与研究，其中男性67名，女性59名，平均年龄(21.4±2.3)岁。C0-C7前凸角平均为26.0°±12.8°，其中C0-C2前凸角平均为15.2°±6.7°，C2-C3到C6-C7间盘前凸角总和平均为9.1°±12.1°，C3到C7的椎体前凸角总和平均仅为1.4°±10.2°。C2-C7SVA(18.6±7.9) mm和CGH-C7SVA[(22.9±12.3) mm]由C7-S1SVA[(-21.6±31.0) mm]完美代偿。不同的Roussouly分型间颈椎曲度差异有统计学意义(P < 0.01)。颈椎曲度与T1倾斜角(P < 0.01)、胸椎后凸角(P < 0.01)有显着相关性。从T1倾斜角到C0-C2角，相邻节段间盘角之间存在显著相关性(P < 0.05)。结论: 测量并计算了无症状中国年轻人颈椎椎体角和间盘角的正常值，发现颈椎前凸主要发生在C0-C2和椎间盘水平，这些角度受到其他脊柱部位形态(T1倾斜角、胸椎后凸角和Roussouly分型)的影响，且相邻间盘角之间存在显著的相关性。

关键词: 颈椎, 矢状位曲度, 间盘角, 椎体角, 全脊柱平衡

Abstract:

Objective: To explore the normal distribution of cervical sagittal alignment and the relationship between cervical alignment and global spine balance in asymptomatic young adults. Methods: A cohort of 272 asymptomatic Chinese adults (including 161 males and 111 females, with an average age of (23.2±4.4) years, ranging from 18 to 45 years) were prospectively recruited from November 2011 to December 2014. The C0-C2 angle, disk angles from C2-C3 to C6-C7, vertebral angles from C3 to C7, T1 slope, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), C2-C7 sagittal vertical axis (C2-C7SVA), center of gravity of head to C7SVA (CGH-C7SVA), C7-S1SVA were measured and statistically analyzed. All the subjects were categorized with the Roussouly classification and the cervical morphologies were evaluated as lordotic, straight, sigmoid or kyphotic. Spinal sagittal alignment parameters were compared between different sexes and Roussouly classifications with independent student t test, analysis of variance (ANOVA) or Chi-square test. Correlations between cervical sagittal alignment and global spine sagittal alignment were calculated using the Pearson and Spearman correlation coefficient. Linear regression analysis was performed. Results: Sixty-seven males and 59 females aged from 18 to 30 years old were included in the study. The mean value of C0-C7 was 26.0°±12.8°, composed of 15.2°±6.7° for C0-C2, 9.1°±12.1° for sum of disk angles from C2-C3 to C6-C7, and 1.4°±10.2° for sum of vertebral angles from C3 to C7. C2-C7SVA [(18.6±7.9) mm] and CGH-C7SVA [(22.9±12.3) mm]were offset ideally by C7-S1SVA [(-21.6±31.0) mm]. Males had a larger T1 slope (P < 0.05) and accordingly, a larger cervical lordosis C2-C7 (P < 0.01) and C0-C7 angle (P < 0.01) than females. Males had a smaller C7-S1SVA (P < 0.01) and accordingly, a smaller CGH-C7SVA (P=0.165) than females. Significant difference was found between cervical alignment of different Roussouly types (P < 0.01). In general, a larger LL was consistent with a set of larger TK, C2-C7angle, C0-C7 angle, and vice versa. There was no significant correlation between cervical morphology and the Roussouly classification (Chi-square=10.548, P=0.308). There was significant correlation between cervical alignment and T1 slope (P < 0.01), TK (P < 0.01). There was significant correlation between adjacent segmental angles from T1 slope up to C0-C2 angle (P < 0.05). Conclusion: Normative values of each vertebral angle and disk angle were established. The cervical lordosis occurred mainly at C0-C2 and disk levels, which was influenced by parameters of other parts of the spine, such as T1 slope, TK and the Roussouly classification. There was significant correlation between adjacent disk angles.

Key words: Cervical spine, Sagittal alignment, Disk angle, Vertebral angle, Global spine balance

中图分类号: 

  • R681.5

图1

颈椎曲度测量示意图"

表1

不同性别的人口学资料和矢状位曲度平均值"

Parameter and demographics Female (n=59) Male (n=67) P Total (n=126)
Age/years 21.1±2.4 21.6±2.2 0.294 21.4±2.3
Height/mm 163.2±4.4 175.4±5.5 < 0.001* 169.7±7.9
Weight/kg 52.7±6.0 66.3±8.3 < 0.001* 60.0±9.9
BMI 19.8±2.1 21.5±2.1 < 0.001* 20.7±2.3
Cervical alignment
    C0-C2/(°) 15.5±7.3 14.9±6.2 0.480 15.2±6.7
    C2-C3/(°) 1.0±3.3 2.3±3.5 0.034* 1.7±3.5
    C3/(°) 0.2±3.7 0.9±3.4 0.307 0.6±3.5
    C3-C4/(°) 1.3±3.7 1.0±3.8 0.662 1.1±3.7
    C4/(°) -0.9±3.2 0.8±3.6 0.005# 0.0±3.5
    C4-C5/(°) 0.4±2.9 1.2±3.9 0.177 0.8±3.5
    C5/(°) -1.8±3.3 -0.5±3.4 0.027* -1.1±3.4
    C5-C6/(°) 0.9±3.9 1.8±3.3 0.176 1.4±3.6
    C6/(°) -0.6±3.2 -0.3±3.5 0.601 -0.4±3.3
    C6-C7/(°) 4.0±3.6 4.2±3.7 0.810 4.1±3.7
    C7/(°) 2.1±2.8 2.6±2.7 0.230 2.4±2.8
    C2-C7/(°) 6.6±13.1 14.1±13.2 0.002# 10.6±13.6
    C0-C7/(°) 22.6±11.1 28.9±13.5 0.006# 26.0±12.8
    T1 slope/(°) 24.7±7.4 27.4±6.5 0.034* 26.1±7.0
    C2-C7SVA/mm 18.9±6.3 18.3±9.1 0.674 18.6±7.9
    CGH-C7SVA/mm 24.5±11.5 21.4±12.9 0.165 22.9±12.3
Whole spine alignment
    TK/(°) 24.4±7.2 24.8±7.1 0.779 24.6±7.1
    LL/(°) 47.9±9.5 48.1±9.9 0.871 48.0±9.7
    PI/(°) 48.1±8.3 47.6±8.4 0.717 47.8±8.3
    SS/(°) 36.9±6.7 37.9±7.3 0.415 37.4±7.0
    PT/(°) 10.9±5.6 9.7±6.6 0.254 10.3±6.2
    C7-S1 SVA/mm -29.1±30.9 -14.9±29.7 0.009# -21.6±31.0

图2

颈椎曲度的分布"

表2

不同Roussouly分型的脊柱矢状位曲度平均值"

Parameter Type 1 (n=20) Type 2 (n=42) Type 3 (n=42) Type 4 (n=22) P
SS/(°) < 35° < 35° 35°-45° >35° 0.000#
Cervical alignment
    C0-C2/(°) 14.5±7.2 14.1±7.1 16.5±6.2 15.5±6.7 0.426
    C2-C3/(°) 1.3±3.3 2.1±3.8 1.5±3.4 1.6±3.4 0.806
    C3/(°) 2.4±3.4 0.6±3.3 0.4±3.5 -0.6±3.6 0.051
    C3-C4/(°) 1.8±4.3 0.7±3.8 0.7±3.7 2.1±3.2 0.375
    C4/(°) 1.3±3.3 0.0±3.7 -0.2±3.4 -0.8±3.6 0.250
    C4-C5/(°) 1.9±2.9 0.0±4.1 0.5±3.1 2.3±3.1 0.036*
    C5/(°) -0.2±3.4 -1.2±3.2 -1.4±3.4 -1.3±3.9 0.626
    C5-C6/(°) 1.8±2.3 0.6±4.0 1.2±3.4 2.9±3.8 0.088
    C6/(°) 0.9±2.6 -1.1±3.3 -0.5±4.0 0.0±2.2 0.142
    C6-C7/(°) 4.5±3.0 3.9±4.3 3.5±3.0 5.3±3.8 0.246
    C7/(°) 3.3±2.7 2.3±2.6 2.0±3.1 2.3±2.2 0.388
    C2-C7/(°) 18.9±14.1 7.8±14.2 7.7±11.1 13.9±13.5 0.005#
    C0-C7/(°) 33.4±11.5 21.9±14.5 24.7±10.0 29.4±12.2 0.004#
    T1 slope/(°) 27.8±7.2 24.3±7.3 26.7±6.4 27.1±7.0 0.204
    C2-C7 SVA/mm 17.5±9.6 19.3±7.3 19.4±7.9 16.7±7.4 0.499
    CGH-C7 SVA/mm 19.1±15.9 23.3±10.5 24.3±12.5 22.8±11.4 0.485
Whole spine alignment
    TK/(°) 25.9±7.6 20.9±7.1 26.0±6.3 27.8±5.5 0.000#
    LL/(°) 47.3±10.0 43.9±9.1 49.7±9.0 53.3±8.9 0.001#
    PI/(°) 43.3±5.9 43.6±7.0 50.7±7.4 54.7±7.6 0.000#
    SS/(°) 33.0±7.1 34.1±4.3 38.4±5.3 46.0±6.3 0.000#
    PT/(°) 10.4±6.0 9.5±5.5 12.0±6.7 8.5±6.1 0.126
    C7-S1SVA/mm -28.2±27.5 -19.4±31.9 -24.5±33.2 -14.1±27.7 0.436

表3

不同Roussouly分型之间的颈椎形态比较"

Items Lordotic Straight Sigmoid Kyphotic Total
Type 1 9 9 0 2 20
Type 2 14 22 0 6 42
Type 3 7 28 2 5 42
Type 4 9 11 1 1 22
Total 39 70 3 14 126

表4

颈椎矢状位曲度和全脊柱矢状位曲度的相关性"

Items C2-C7 C0-C7 C2-C7SVA CGH-C7SVA
T1 slope 0.419# 0.463# 0.274# 0.209*
TK 0.240# 0.319# 0.166 -0.048
LL 0.015 0.115 0.052 0.026
PI -0.071 -0.020 -0.009 0.045
SS -0.011 0.029 0.019 0.019
C7-S1SVA 0.159 0.058 -0.025 -0.022

表5

颈椎矢状位曲度及T1倾斜角之间的相关性"

C0-C2 C2-C3 C3-C4 C4-C5 C5-C6 C6-C7 C2-C7 C0-C7 T1 slope
C0-C2 1 -0.364# -0.206* -0.222* -0.132 -0.113 -0.349# 0.158 0.079
C2-C3 1 0.408# 0.273# 0.128 0.031 0.417# 0.248# 0.058
C3-C4 1 0.544# 0.469# 0.186* 0.525# 0.449# 0.175
C4-C5 1 0.610# 0.215* 0.632# 0.564# 0.322#
C5-C6 1 0.349* 0.488# 0.439# 0.353#
C6-C7 1 0.280# 0.226* 0.074
C2-C7 1 0.870# 0.419#
C0-C7 1 0.463#
T1 slope 1
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