根据 Roussouly 胸腰椎亚型的颈椎和颈胸段矢状位排列。
Cervical and Cervicothoracic Sagittal Alignment According to Roussouly Thoracolumbar Subtypes.
机构信息
Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
出版信息
Spine (Phila Pa 1976). 2019 Jun 1;44(11):E634-E639. doi: 10.1097/BRS.0000000000002941.
STUDY DESIGN
Cross-sectional cohort.
OBJECTIVE
To determine normative radiographic sagittal cervical alignment in asymptomatic volunteers based on Roussouly thoracolumbar sagittal alignment subtypes.
SUMMARY OF BACKGROUND DATA
Comprehension of differences in cervicothoracic alignment with respect to variations in thoracolumbar alignment is limited.
METHODS
Asymptomatic adults were recruited and the following parameters measured: PI, PT, SS, LL, orbital tilt, orbital slope, occipital slope and incidence, occiput-C2 lordosis, C2-7 lordosis, occiput-C7 lordosis, CBVA, T1 slope, cervicothoracic alignment, T2-5 kyphosis, and C2-C7 sagittal vertebral alignment (SVA). Each was classified into one of Roussouly's four thoracolumbar subtypes and cervical alignment parameters were compared between groups.
RESULTS
Eighty-seven individuals [male-23; female-64; average age 49 ± 16 yr (22-77 yr)] were included for analysis. The four groups were not different by age, sex, and body mass index (BMI). Lumbopelvic parameters (PI, SS, PT, LL) were different between Roussouly types. Average values for all patients included: CBVA (-1 ± 9°), occiput-C2 lordosis (28 ± 9°), occiput-C7 lordosis (39 ± 14°), C2-7 lordosis (11 ± 14°), C2-7 SVA (21 ± 9 mm), T1 slope (25 ± 9°), C6-T4 angle (5 ± 8°), T2-5 angle (16 ± 7°), thoracic kyphosis (47 ± 13°). No sagittal radiographic alignment measurements of the cervical spine and cervicothoracic junction were different between groups, except for the global cervical lordosis (occiput-C7 Cobb), which was found to be lowest for Roussouly type 2 (35 ± 14°) and highest for type 4 (48 ± 14°) (P = 0.01). Mean C2-C7 sagittal Cobb, T2-T5 sagittal Cobb, and T1 slope were not different between groups.
CONCLUSIONS
In asymptomatic volunteers, normative sagittal alignment parameters of the cervical spine, cervicothoracic junction, and thoracic spine based on variations in thoracolumbar sagittal alignment, as proposed by Roussouly, are established. These data may guide surgical correction of cervicothoracic deformities to ensure appropriate restoration of normal cervicothoracic parameters to maintain good horizontal gaze and overall sagittal plane alignment.
LEVEL OF EVIDENCE
研究设计
横断面队列研究。
目的
根据 Roussouly 胸腰椎矢状面分型，确定无症状志愿者的正常颈椎矢状位排列。
背景资料概要
对颈椎与胸腰椎排列差异的理解有限。
方法
招募无症状成年人，并测量以下参数：PI、PT、SS、LL、眶倾斜度、眶斜率、枕骨斜率和倾斜度、枕骨-C2 前凸、C2-7 前凸、C7 枕骨前凸、Cobb 角、T1 斜率、颈椎-胸椎矢状面排列、T2-5 后凸、C2-C7 矢状位椎体排列（SVA）。将每个参数分为 Roussouly 四种胸腰椎亚型之一，并比较组间颈椎排列参数。
结果
共纳入 87 名受试者[男性 23 名；女性 64 名；平均年龄 49±16 岁（22-77 岁）]。四组间年龄、性别和体重指数（BMI）无差异。腰骶参数（PI、SS、PT、LL）在 Roussouly 分型之间存在差异。所有患者的平均数值包括：Cobb 角（-1±9°）、枕骨-C2 前凸（28±9°）、枕骨-C7 前凸（39±14°）、C2-7 前凸（11±14°）、C2-7 SVA（21±9mm）、T1 斜率（25±9°）、C6-T4 角（5±8°）、T2-5 角（16±7°）、胸椎后凸（47±13°）。除 Roussouly 型 2 的整体颈椎前凸（C7 枕骨 Cobb）最低（35±14°），Roussouly 型 4 最高（48±14°）外，各组间颈椎和颈椎-胸椎交界处的颈椎矢状位影像学排列测量值无差异（P=0.01）。各组间 C2-C7 矢状 Cobb、T2-T5 矢状 Cobb 和 T1 斜率无差异。
结论
在无症状志愿者中，基于 Roussouly 提出的胸腰椎矢状面排列的颈椎、颈椎-胸椎交界处和胸椎的正常矢状位排列参数已经建立。这些数据可能有助于指导颈椎-胸椎畸形的手术矫正，以确保适当恢复正常的颈椎-胸椎参数，以维持良好的水平凝视和整体矢状面排列。
证据水平
3 级。
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