Yoganandan Narayan, Banerjee Anjishnu, DeVogel Nicholas, Pintar Frank A, Baisden Jamie L
Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Center for NeuroTrauma Research, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Division of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
World Neurosurg. 2018 Nov;119:e962-e967. doi: 10.1016/j.wneu.2018.08.011. Epub 2018 Aug 13.
To determine role of lordosis in cervical spine injuries using a novel competing risk analysis model.
The first subgroup of published experiments (n = 20) subjected upright human cadaver head-neck specimens to impact loading. The natural lordosis was removed. The second (n = 21) and third (n = 10) subgroups of published tests subjected inverted specimens to head impact loading. Lordosis was preserved in these 2 subgroups. Using axial force and age as variables, competing risks analysis techniques were used to determine the role of lordosis in the risk of bone-only, ligament-only, and bone and ligament injuries.
Bony injuries were focused more at 1 level to a straightened spine, and ligament injuries were spread around multiple levels. Age was not a significant (P < 0.05) covariate. A straightened spine had 3.23 times higher risk of bony injuries than a lordotic spine. The spine with maintained lordosis had 1.14 times higher risk of ligament injuries, and 2.67 times higher risk of bone and ligament injuries than a spine without lordosis (i.e., preflexed column).
Increased risk of bony injuries in a preflexed spine and ligament injuries in a lordotic spine may have implications for military personnel, as continuous use of helmets in the line of duty affects the natural curvature; astronauts, as curvatures are less lordotic after missions; and civilian patients with spondylotic myelopathy who use head protective devices, as curvatures may change over time in addition to the natural aging process.
使用一种新型竞争风险分析模型来确定脊柱前凸在颈椎损伤中的作用。
已发表实验的第一亚组（n = 20）对直立的人体尸体头颈部标本施加冲击载荷。去除自然脊柱前凸。已发表测试的第二亚组（n = 21）和第三亚组（n = 10）对倒置的标本施加头部冲击载荷。这两个亚组保留了脊柱前凸。以轴向力和年龄作为变量，使用竞争风险分析技术来确定脊柱前凸在单纯骨损伤、单纯韧带损伤以及骨和韧带联合损伤风险中的作用。
骨损伤更多集中在脊柱变直的1个节段，而韧带损伤分布在多个节段。年龄不是显著（P < 0.05）的协变量。脊柱变直时发生骨损伤的风险比脊柱前凸时高3.23倍。与无脊柱前凸（即预弯曲柱）的脊柱相比，保持脊柱前凸的脊柱发生韧带损伤的风险高1.14倍，发生骨和韧带联合损伤的风险高2.67倍。
预弯曲脊柱中骨损伤风险增加以及脊柱前凸脊柱中韧带损伤风险增加可能对军事人员有影响，因为在执行任务中持续佩戴头盔会影响自然曲度；对宇航员有影响，因为任务后曲度的脊柱前凸程度减小；对使用头部保护装置的脊髓型颈椎病 civilian 患者也有影响，因为除了自然衰老过程外，曲度可能随时间变化。
