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目的:测量青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者上颈椎序列参数,探讨各参数间的相关关系及其在维持前视平衡中所起的作用。方法:回顾性分析2014年1月~2016年1月期间就诊的196例AIS患者,排除其中资料不全者、接受过治疗者、患有影响脊柱序列疾病者以及上胸段脊柱侧凸累及颈段者,共有103例患者纳入研究,其中男26例,女77例,年龄10~17岁(14.66±2.31岁)。在脊柱侧位X线片上测量颈椎Cobb角(cervical Cobb angle,CCA)、C0-C2角(occiput-C2 angle)、C1-C2角(C1-C2 angle)、硬腭-C2角(palatum-C2 angle)、C2椎体轮廓线(C2 vertebra contour angle)、C1-C7矢状面轴向距离(C1-C7 SVA)、T2倾斜角(T2 sagittal tilt)。根据Lenke胸椎修正分型(修正+、修正N、修正-)将患者分为(+)、N、(-)3组,比较各组间参数的差异性以及各参数间的相关性。结果:颈椎Cobb角10.29°±8.65°;C0-C2角13.86°±8.33°;C1-C2角25.61°±9.17°;硬腭-C2角12.06°±8.91°;C2椎体轮廓线98.43°±6.75°;C1-C7矢状面轴向距离28.41±10.69mm;T2倾斜角10.73°±8.11°。在Lenke胸椎修正分组中颈椎Cobb角及T2倾斜角在各组间有统计学差异(P<0.05)。C0-C2角、C1-C2角、C1-C7矢状面轴向距离、硬腭-C2角相互之间有显著性正相关(P<0.01)。结论:AIS患者的T2倾斜角很大程度上受到T5~T12后凸的影响。当AIS患者的颈椎在矢状位发生位移减少时,机体可通过减小C1-C2角来维持前视平衡。
OBJECTIVE: To measure the parameters of the cervical spine sequence in adolescent idiopathic scoliosis (AIS) patients and to explore the correlation between the parameters and its role in maintaining the balance of frontal vision. METHODS: A retrospective analysis of 196 AIS patients treated between January 2014 and January 2016 was performed, exclusion of those with data failure, those who received treatment, patients with disorders affecting the spinal column, and upper thoracic scoliosis involving the cervical segment A total of 103 patients were included in the study, including 26 males and 77 females, aged 10-17 years (14.66 ± 2.31 years). The cervical Cobb angle (CCA), C0-C2 angle, C1-C2 angle, palatum-C2 angle ), C2 vertebra contour angle, C1-C7 sagittal axial distance (C1-C7 SVA) and T2 sagittal tilt. The patients were divided into (+), N and (-) groups according to Lenke thoracic revision classification (modified +, modified N, corrected-). The differences of parameters among groups and the correlation between the parameters were compared. Results: The Cobb angle of the cervical vertebra was 10.29 ° ± 8.65 °, the angle of C0-C2 was 13.86 ° ± 8.33 °, the angle of C1-C2 was 25.61 ° ± 9.17 °, the angle of the hard palate-C2 was 12.06 ° ± 8.91 ° and the contour of C2 vertebra was 98.43 ° ± 6.75 °; C1-C7 sagittal plane axial distance 28.41 ± 10.69mm; T2 tilt angle 10.73 ° ± 8.11 °. In the Lenke thoracic correction group, the Cobb angle and T2 tilt angle of the cervical spine were significantly different among the groups (P <0.05). C0-C2 angle, C1-C2 angle, axial distance of C1-C7 sagittal plane, and hard palate-C2 angle had significant positive correlation with each other (P <0.01). Conclusion: T2 tilt angle of AIS patients is greatly affected by T5 ~ T12 kyphosis. When the AIS patient’s cervical vertebra is displaced in the sagittal plane, the body can maintain the forward balance by reducing the C1-C2 angle.