颈椎后纵韧带骨化累及C<sub>2</sub>椎体对颈椎矢状面参数影响的影像学研究

doi:10.3760/cma.j.cn101202-20211219-00387

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摘要目的探讨累及C₂椎体的颈椎后纵韧带骨化症（OPLL）对颈椎矢状面形态及其参数的影响。方法回顾性研究。纳入2016年1月—2020年12月徐州医科大学附属医院脊柱外科颈椎OPLL患者97例,其中男68例、女29例,年龄37~80（59.0±9.6）岁。根据骨化物是否累及C₂椎体将患者分为2组,OPLL累及C₂椎体36例为C₂阳性组,未累及C₂椎体 61例为C₂阴性组。在立位颈椎侧位X线片上测量C_0~2及C_2~7颈椎前凸角（CL）、C₂倾斜角（C₂S）、胸廓入口角（TIA）、T₁倾斜角（T₁S）、颈倾角（NT）、枕颈倾斜角（OCI）、C_2~7矢状轴距离（SVA）等矢状面参数。观察项目：（1）对比2组患者性别、年龄、日本骨科协会（JOA）评分、颈椎功能障碍指数（NDI）评分等临床一般资料;（2）比较2组患者骨化物累及的颈椎节段、椎管侵占率、OPLL分型以及影像学上有无脊髓高信号、骨化物是否触及K线的情况;（3）比较2组间颈椎矢状面各项影像学参数的差异,分别对2组内矢状面各影像学参数进行相关性分析;（4）对OPLL累及C₂的危险因素进行多因素logistic回归分析。结果 2组患者性别、年龄、JOA评分差异均无统计学意义（P值均>0.05）。C₂阳性组骨化物累及颈椎节段数（4.6±1.2）个、椎管侵占率52.42%±9.96%、NDI评分（21.08±7.65）分,均高于C₂阴性组的（3.1±0.9）个、45.87%±13.08%、（17.70±8.49）分,差异均有统计学意义（P值均<0.05）。在OPLL分型上,C₂阳性组和C₂阴性组分型构成比差异有统计学意义（P<0.001）。2组间骨化物触及K线率、脊髓高信号率差异均无统计学意义（P值均>0.05）。颈椎矢状面各项影像学参数中,仅C₂阳性组C₂S（11.25°±5.84°）高于C₂阴性组（7.66°±5.65°）,差异有统计学意义（t=2.99, P=0.004）。2组内颈椎矢状面影像参数相关性分析显示：C₂阳性组中,C₂S与C_0~2CL、C_2~7SVA呈正相关（r=0.52、0.80,P值均<0.05）;C₂阴性组中,C₂S与C_0~2CL、C_2~7SVA呈正相关,与C_2~7CL呈负相关（r=0.43、0.71、-0.39,P值均<0.05）。多因素logistic回归显示,C₂S增大[比值比（OR）=1.208,95%可信区间（CI）1.032~2.210,P=0.014]和骨化物累及颈椎节段数（OR=3.026,95% CI 2.136~5.076,P=0.001）为OPLL累及C₂的独立性危险因素。结论颈椎OPLL累及C₂者以累及节段更多和椎管侵占率更高为特点,在颈椎矢状面影像学参数上表现为更高的C₂S,且C₂S和骨化物累及颈椎节段数为OPLL累及C₂的独立危险因素。

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	曲哲
	马胜
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	潘彬
	冯虎
	袁峰

关键词 ：后纵韧带骨化, 第2颈椎, 颈椎矢状面参数, 第2颈椎倾斜角

Abstract：Objective This study explores the influences of the C₂ involvement of the cervical ossification of the posterior longitudinal ligament (OPLL) on cervical sagittal plane morphology and its parameters. Methods A retrospective review was conducted, enrolling 97 patients who had cervical OPLL and were treated in the department of spinal surgery of the Affiliated Hospital of Xuzhou Medical University from January 2016 to December 2020. The patients were composed of 68 males and 29 females aged 37-80 (59.0 ± 9.6) years. According to the involvement of C₂ of cervical OPLL, all cases were divided into C₂ positive group (36 cases) and C₂ negative group (61 cases). Cervical sagittal parameters were measured on the standing lateral radiographs of the cervical spine, including cervical lordosis (CL), C₂ slope (C₂S), thoracic inlet angle, T₁ slope, neck tilt, and C_2~7 sagittal vertebral axis (SVA ). Observation parameters included (1) comparison of sex, age, and Japanese orthopedic association (JOA) score, neck disability index (NDI) score, and other clinical data between two groups; (2) differences in radiological features, such as OPLL level, occupational ratio, cervical OPLL subtype, high intensity signal on MRI, and K-line touch were analyzed; (3) comparison between the cervical sagittal parameters of the two groups, correlation analysis among these parameters in each group; (4) the multiple logistic regression for identifying the risk factors for C₂ involvement. Results No significant difference in gender, age, and JOA score was found between the two groups (all P values > 0.05). The levels OPLL involved, occupational ratio, and NDI score in the C₂ positive group was 4.6±1.2, 52.42%±9.96%, and 21.08±7.65, respectively, which were significantly higher than those in C₂ negative group with values of 3.1±0.9 (OPLL level), 45.87%±13.08% (occupational ratio), and 17.70±8.49 (NDI score) (all P values < 0.05). In terms of OPLL classification, the constituent ratio of OPLL type was different between the two groups (P < 0.001). No obvious differences in the touch of K-line and the high intensity signal on MRI were observed (all P values > 0.05). Compared with cervical sagittal parameters, only C₂S in the C2 positive group (11.25°±5.84°) was higher than that in the C2 negative group (7.66°±5.65°), and the difference was statistically significant (t=2.99, P=0.004). Correlative analysis showed that C₂S had positive correlations with C_0~2 CL and C_2~7SVA (r=0.52, 0.80, all P values < 0.05) in the C₂ positive group. In the C₂ negative group, C₂S was positively correlated with C_0~2 CL and C_2~7SVA but negatively correlated with C_2~7 CL (r = 0.43, 0.71, -0.39, all P values < 0.05). Multivariate logistic regression showed that C₂S increases (odds ratio [OR]=1.208, 95% confidence interval [CI]: 1.032-2.210, P=0.014), and the number of cervical spine segments involved by ossifiers (OR =3.026, 95%CI: 2.136-5.076, P=0.001) were independent risk factors for C₂ involvement by OPLL. Conclusion Patients with OPLL extended to the C₂ segment show that more involved levels and higher occupational ratio in radiological features. Cervical sagittal parameters are featured as a higher C₂S, and C₂S and levels involved are identified as the independent risk factors of C₂ involvement.

Key words： Ossification of posterior longitudinal ligament The second cervical vertebrae Cervical sagittal parameter C₂ slope

收稿日期: 2021-12-19

通讯作者: 冯虎,Email：XZSpine@126.com

引用本文:

曲哲, 马胜, 高啸, 潘彬, 冯虎, 袁峰. 颈椎后纵韧带骨化累及C₂椎体对颈椎矢状面参数影响的影像学研究[J]. 中华解剖与临床杂志, 2022, 27(10): 684-690.
Qu Zhe, Ma Sheng, Gao Xiao, Pan Bin, Feng Hu, Yuan Feng. Imaging study on the effect of cervical posterior longitudinal ligament ossification involving C₂ vertebral body on the sagittal parameters of cervical spine. Chinese Journal of Anatomy and Clinics, 2022, 27(10): 684-690.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20211219-00387 或 http://www.cjac.com.cn/CN/Y2022/V27/I10/684

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