上下颈椎矢状位序列和T1 slope相关性的影像学研究

发布时间：2018-06-23 14:45

本文选题：T1 + Slope　；参考：《吉林大学》2017年硕士论文

【摘要】：研究目的:明确在颈椎前凸和后凸患者中,T1 slope和上下颈椎矢状位序列之间的关系研究背景:颈椎在支撑头部重量的同时维持视线水平。在矢状位上,头部的重心正好位于外耳道前1cm的枕髁处(occipital condyle)以维持最小的能量输出,当头部序列发生任何偏移,都会使力臂改变进而引起肌肉收缩,能量输出。Louis第一次提出颈椎椎体的稳定性是通过特有的三柱理论承担(1前柱2后柱),分别由前方椎体和后方关节突构成,Pal和Sherk后来研究证实了该理论的重要性。头部负荷首先通过C-1侧块传递至C1-2关节突,再由C-2椎体传递至C2-3间盘及后方C2-3关节突,前方椎体及后方关节突分别承担36%和64%的负荷。相比和胸腰椎不同(70%和30%)是,颈椎后方关节突承担了更大的负荷。颈椎生理性前凸不仅能更好的维持头部重量,并且能够代偿胸椎后凸及整体矢状位序列,维持整体的平衡。颈胸交界区(胸廓入口区)是由活动度较大的颈椎过度过渡到相对固定的胸廓移形而成的。颈椎及胸廓入口参数的异常变化都和颈部疼痛与功能障碍相关。研究方法:选取2014年9月-2015年12月就诊于中日联谊医院门诊存在颈部非特异性疼痛患者,站立位能维持水平视线(cbva5°-17°;mcgregor’s-6°-14°;3.sls-5.1°~18.5°)的x线资料,610名患者纳入到本研究。共纳入610位(309男性,301女性)无颈椎特异性疼痛的患者,所有患者都不存在神经压迫症状,平均年龄42.18岁(17-76岁)。通过患者颈椎正侧位片测量患者颈椎序列,包括cbva(chinbrowverticalangle)、mcgregor’sslope、sls(slopeoflightofsight)、c0-1cobb、c1-2cobb、c2-7cobb、c2-7sva、t1slope和ts-cl(t1slopeminuscervicallordosis)。通过视线水平筛选后,根据患者c2-7cobb角度分成前凸组和后凸组。通过pearson和线性回归分析明确数据之间的相关性。方差分析比较前后凸组各数据间差异。研究结果:610名患者纳入到本研究。前凸组507名(83.1%256男性,251女性)患者,平均年龄43.38±13.88岁(18-76)。后凸组103名(16.9%;49男,54女),平均年龄36.23岁(18-68)。组间及组内可靠性(substantial)一致性均较好析(0.79-0.93)。前凸组c01cobb=4.90±4.78°(-8.90-27.80°);c12cobb=26.72±6.80°(6.3-50.0°);c02cobb=31.62±8.20°(10.30-58.60°);c27cobb=17.90±9.94°(-31.40-49.50°);c27sva=13.2±10.30mm(-17-82.17mm);t1s=19.70±10.81°(-7.75-80.92);tscl=1.79±12.45°(-33.25-66.52°)。后凸组c01cobb=7.22±5.79°(-7.70-23.80°);C12Cobb=29.95±5.79°(12.7-52.2°);C02Cobb=37.08±9.60°(14.90-73.60°);C27Cobb=-0.38±7.76°(-20.60-7.50°);C27SVA=17.32±10.29mm(0-56.44mm);T1S=20.7±7.71°(4.20-53.00°);TSCL=21.16±10.23°(-5.90-56.10°)。在两组中,C0-1Cobb(P0.01)、C1-2Cobb(P0.01)、C0-2Cobb(P0.01)、C2-7SVA(P0.01)和TS-CL(P0.01)存在明显差异,但是T1 slope两组之间无差异。两组相关性分析,C2-7 SVA和T1slope(r2=0.712 vs r2=0.467)与TS-CL(r2=0.810 vs r2=0.248)之间均存在明显相关性。研究结论:本研究明确了两种不同颈椎序列其矢状位参数的差异性,体现了不同形态之间代偿的差异性。下颈椎在维持视线水平和整体序列平衡中扮演重要作用。在评估颈椎前凸患者矢状位序列时,TS-CL比T1slope更具优势。
[Abstract]:Objective: to determine the relationship between the T1 slope and the sagittal sequence of the upper and lower cervical spine in the cervical lordosis and kyphosis patients: the cervical spine maintains the line of sight while supporting the weight of the head. At the sagittal position, the center of gravity is located just at the occipital condyle at the anterior 1cm of the outer auditory canal (occipital condyle) to maintain the minimum energy output, Any shift in the head sequence makes the force arm change and cause muscle contraction. Energy output.Louis first suggests that the stability of the vertebral body is borne by the unique three column theory (1 anterior column 2 post), which are composed of the anterior vertebral body and the posterior articular process, respectively. Pal and Sherk later confirmed the importance of the theory. Head load. First passes through the C-1 lateral mass to the C1-2 joint process, then transferred from the C-2 vertebral body to the C2-3 disc and the rear C2-3 joint process. The anterior vertebral body and the posterior articular process bear 36% and 64% load respectively. The posterior cervical vertebrae, unlike the thoracolumbar vertebrae (70% and 30%), bear a greater burden. Weight, and can compensate for the thoracic kyphosis and the overall sagittal sequence to maintain the overall balance. The neck and chest junction area (the thoracic entrance area) is formed by excessive mobility of the cervical vertebra to a relatively fixed thoracic movement. The abnormal changes in the cervical and thoracic entrance parameters are related to neck pain and dysfunction. In December -2015 -2015 in December September 2014, there were 610 patients with non specific pain in the clinic of China Japan Friendship Hospital. The X-ray data of standing line of sight (cbva5 degree -17; McGregor 'S-6 -14; 3.sls-5.1 degree ~18.5) were included in this study. The patients were included in this study. The patients were included in the patients (309 men, 301 women) without cervical specific pain. There were no symptoms of nerve compression in the patients, with an average age of 42.18 years (17-76 years). The cervical vertebra sequence was measured by the positive lateral cervical spine of the patients, including cbva (chinbrowverticalangle), McGregor 'sslope, SLS (slopeoflightofsight), c0-1cobb, c1-2cobb, c2-7cobb, c2-7sva, t1slope, and ts-cl. After plain screening, the patients were divided into the protruding and the kyphosis groups according to the patient's c2-7cobb angle. The correlation between the data was determined by Pearson and linear regression. The variance analysis was used to compare the differences between the data in the front and back groups. The results were compared with the results of the study. 610 patients were included in this study. The 507 (83.1%256 male, 251 female) patients in the lordosis group were 43.38 + 13.88. Age (18-76). 103 (16.9%; 49 men, 54 women) in the kyphosis group, with an average age of 36.23 years (18-68). The consistency of reliability (substantial) between groups and groups was better (0.79-0.93). The group was c01cobb=4.90 + 4.78 degrees (-8.90-27.80); c12cobb=26.72 + 6.80 [(6.3-50.0]); c02cobb=31.62 + 8.20 [10.30-58.60]; c27cobb=17.90 + 9.94 degrees (-31.40-49.50); C 27sva=13.2 + 10.30mm (-17-82.17mm); t1s=19.70 + 10.81 (-7.75-80.92); tscl=1.79 + 12.45 degree (-33.25-66.52). C01cobb=7.22 + 5.79 [degree] in the kyphosis group; C12Cobb=29.95 + 5.79 degrees (12.7-52.2); C02Cobb=37.08 9.60 [degree]; 71 degrees (4.20-53.00 degrees); TSCL=21.16 + 10.23 degrees (-5.90-56.10 degrees). In the two groups, there are obvious differences between C0-1Cobb (P0.01), C1-2Cobb (P0.01), C0-2Cobb (P0.01), C2-7SVA (P0.01) and TS-CL. The two groups of correlation analysis are between the two groups. The difference between the sagittal parameters of the two different cervical spine sequences was clearly defined and the difference in the compensatory difference between different forms was shown. The lower cervical spine plays an important role in maintaining the line of sight and the overall sequence balance. In evaluating the sagittal sequence of the cervical lordosis patients, the TS-CL is more than T1slope. Advantage.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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