Endo Kenji, Kudo Yoshifumi, Suzuki Hidekazu, Aihara Takato, Matsuoka Yuji, Murata Kazuma, Takamatsu Taichiro, Sawaji Yasunobu, Nishimura Hirosuke, Matsuoka Akira, Ishikawa Koji, Maruyama Hiroshi, Fukutake Katsunori, Wada Akihito, Takahashi Hiroshi, Toyone Tomoaki, Yamamoto Kengo
Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
Department of Orthopaedic Surgery, Showa University School of Medicine, Japan.
J Orthop Sci. 2019 Nov;24(6):1033-1036. doi: 10.1016/j.jos.2019.07.009. Epub 2019 Aug 21.
Dropped head syndrome (DHS) is a low prevalence and the clinical features remain unclear. The purpose of the present study was to clarify the general overview of DHS.
The subjects were 67 consecutive DHS patients (17 men and 50 women; average age 72.9 ± 10.2 years) presenting difficulty of horizontal gaze in up-right position. The patients' background, global spinal alignment, clinical findings and treatment were analyzed.
The peak population of DHS was 75-79-year-old females. The comorbidities included Parkinson's disease in 9 cases, minor trauma in 9 cases, post-cervical operation in 3 cases, mental depression in 3 cases, malignant tumor in 3 cases, diabetes mellitus in 2 cases and rheumatoid arthritis in 2 cases. The C2-C7 cervical coronal vertical axis was distributed more to the right side (2.6 ± 12.8 mm). Regarding sagittal alignment, 24 cases (35.8%) showed negative balanced DHS (N-DHS) and 43 cases (64.2%) showed positive balanced DHS (P-DHS). There were significant differences in C2-C7 angle, T1S, LL and PI-LL between the two groups. Cervical or back pain was present in 62 cases (92.5%), and average numerical rating scale was 3.0 ± 2.6. Fourteen cases (20.9%) recovered (average 11.3 months), but 29 cases (43.3%) did not recover without surgery. Twenty-four cases (35.8%) underwent surgery, 20 for cervical spine and 4 for thoraco-lumbar spine, and horizontal gaze difficulty was improved in all patients post-surgery.
DHS was mainly observed in elderly women. About 20% of DHS patients recovered without surgical treatment. DHS was accompanied by scoliosis in 37.3% of the cases.
低头综合征（DHS）患病率较低，其临床特征尚不清楚。本研究旨在阐明DHS的总体概况。
研究对象为67例连续性DHS患者（男性17例，女性50例；平均年龄72.9±10.2岁），这些患者在直立位时存在水平凝视困难。分析了患者的背景、全脊柱排列、临床发现及治疗情况。
DHS的发病高峰人群为75 - 79岁女性。合并症包括帕金森病9例、轻度外伤9例、颈椎手术后3例、精神抑郁3例、恶性肿瘤3例、糖尿病2例、类风湿关节炎2例。C2 - C7颈椎冠状垂直轴更多地分布在右侧（2.6±12.8mm）。矢状面排列方面，24例（35.8%）表现为负平衡DHS（N - DHS），43例（64.2%）表现为正平衡DHS（P - DHS）。两组在C2 - C7角度、T1S、LL和PI - LL方面存在显著差异。62例（92.5%）患者存在颈部或背部疼痛，平均数字评分量表评分为3.0±2.6。14例（20.9%）患者恢复（平均11.3个月），但29例（43.3%）未经手术未恢复。24例（35.8%）患者接受了手术，其中20例为颈椎手术，4例为胸腰椎手术，所有患者术后水平凝视困难均得到改善。
DHS主要见于老年女性。约20%的DHS患者未经手术治疗而恢复。37.3%的DHS病例伴有脊柱侧弯。
