四种颈椎曲度测量方法的可靠性研究

目的　研究目前四种常用的测量颈椎曲度方法的可靠性。方法　利用 5 3例颈椎侧位 X线片 ,2名医师采用 Borden氏测量法、改良 Borden氐测量法和两种夹角测量法 ,分别测量出颈椎曲度值 ,再进行测量者之间的相关性分析。结果　以 Borden氐法相关系数 (0 .90 1)最大 ,测量方法简单。改良 Borden氐法相关系数 (0 .811)最小。结论　常用的颈椎曲度测量方法中 ,以 Borden氐法最为可靠 ,且方法简单实用     

颈椎曲度和活动度的测量及意义

如何准确测量颈惟曲度和活动度一直是基础和临床研究中很棘手的问题 ,本文就常用的曲度和活动度测量方法及意义作一简述 ;常用的屈度测量方法有 Borden氏法、改良 Borden氏法和夹角测量法等 ,值得推荐的是 Borden氏法 ;颈椎活动度的测量方法相对较多 ,有颈椎动力性摄片法、改良方盘测角仪、脊柱运动分析仪、颈椎活动度测量仪、电动测量仪、皮尺测量和目测等数十种 ,但目前尚无一种切实可靠、能被大多数研究人员公认的活动度测量方法 ;颈椎曲度和活动度的变化能准确地反应颈椎整体功能的变化 ,当颈椎病初发或颈椎病产生症状时 ,往往都有颈椎曲度和活动度的变化 ,颈椎曲度和活动度的变化对颈椎病的早期诊断、对判定颈椎各节段功能及颈椎病变部位都有一定的积极意义     

6种颈椎曲度测量方法的可信度及可重复性比较

目的 :比较6种颈椎曲度测量方法的可信度及可重复性。方法 :随机选取在我科接受颈椎X线检查的80例患者进行标准颈椎侧位拍片,由3名放射科医生采用基于距离[1Borden氏测量法;2颈椎曲度指数(CCI)法;3椎体质心测量法(CCL)测量方法]和基于角度(1C1-C7 Cobb角测量法;2C2-C7 Cobb角测量法;3Harrison氏测量法)共6种测量方法分别测量颈椎曲度。以2周为间隔分别独自测量两次,对测量结果进行统计分析。结果:6种测量方法均具有良好的可信度(r=0.752~0.968)和可重复性(r=0.703~0.915)。基于距离的测量方法中可信度以Borden氏测量法最高(r=0.938~0.968),其次为CCL法(r=0.855~0.908)及CCI法(r=0.775~0.821);可重复性以Borden氏测量法最好(r=0.888~0.915),其次为CCI法(r=0.819~0.862)及CCL法(r=0.810~0.859)。基于角度的测量方法中可信度以C2-C7 Cobb角测量法最高(r=0.871~0.895),其次为Harrison氏法(r=0.830~0.885)及C1-C7 Cobb角测量法(r=0.752~0.836);可重复性以Harrison氏法最好(r=0.868~0.880),其次为C2-C7 Cobb角测量法(r=0.859~0.876)及C1-C7 Cobb角测量法(r=0.703~0.837)。结论 :6种不同的颈椎曲度测量方法均具有良好的可信度及可重复性。基于距离的曲度测量方法以Borden氏测量法可信度及可重复性最好,基于角度的曲度测量方法以C2-C7 Cobb角测量法可信度最高,以Harrison氏法可重复性最好。     

颈椎单椎体次全切除后撑开植骨对颈椎曲度的影响

目的研究中下颈椎前路单椎体次全切减压后,不同高度支撑植骨与颈椎曲度变化之间的关系,为临床确定合适的植骨高度提供参考.方法拍摄6具颈椎标本正常状态、C5椎体次全切除减压后C4与C6椎体间分别以C5椎体以及上下椎间盘高度之和为基础撑开0、2、4、6、8mm支撑植骨状态下的颈椎侧位X线片,并在图形测量软件中测量颈椎曲度.结果C5椎体次全切除减压撑开4mm及以上植骨状态的颈椎曲度和完整状态与不撑开植骨状态相比有显著增加(P＜0.01),减压相邻节段的曲度无明显变化.结论中下颈椎前路单椎体次全切除减压后适宜的支撑植骨高度为撑开4～6mm.     

三维曲度牵引联合电针治疗神经根型颈椎病临床疗效观察

目的:观察三维曲度牵引联合电针治疗神经根型颈椎病的临床疗效。方法:将62例伴有颈椎曲度异常的神经根型颈椎病患者随机分为治疗组和对照组,每组31例。治疗组采用三维曲度牵引联合电针治疗,对照组采用普通坐位枕颌套牵引联合电针治疗。分别在治疗前、治疗后、疗程结束后3个月随访时对2组患者颈椎视觉模拟评分法(VAS)评分、颈椎曲度指数等指标进行观察;治疗后进行临床疗效评定。结果:治疗组痊愈17例,显效8例,有效4例,无效2例,总有效率为93.55%;对照组痊愈9例,显效7例,有效6例,无效9例,总有效率为70.97%。2组比较,差异有统计学意义(P<0.05)。治疗后及随访时,2组VAS评分、颈椎曲度指数较治疗前均有改善(P<0.05),且治疗组优于对照组(P<0.05)。随访时,2组VAS评分、颈椎曲度指数与治疗后比较,差异均有统计学意义(P<0.05)。结论:三维曲度牵引联合电针治疗神经根型颈椎病能明显改善患者的临床症状,纠正或改善患者的异常颈椎曲度,疗效持久确切,值得临床推广使用。     

颈椎曲度异常对椎间盘应力分布影响的有限元分析

目的利用有限元模型研究颈椎曲度变化对椎间盘应力分布的影响。方法根据志愿者颈部CT数据建立曲度正常、变直、后凸3种颈椎有限元模型,计算不同载荷下颈椎间盘的应力分布。结果 (1)同一载荷下,3个颈椎模型中C3～4椎间盘应力最小,C5～6椎间盘应力最大,差异有统计学意义(P 0. 05)。(2)重力载荷作用下,C3～4、C4～5、C5～6、C6～7椎间盘应力曲度后凸模型显著大于曲度正常模型及曲度变直模型(P 0. 05)。(3)前屈+重力载荷下,各模型中椎间盘应力均明显大于单纯重力载荷(P 0. 05),其中C4～5、C5～6椎间盘应力曲度后凸模型和曲度变直模型明显大于曲度正常模型(P 0. 01)。(4)后伸+重力载荷下,各模型椎间盘应力明显小于前屈+重力载荷(P 0. 05)。结论根据颈椎弧度建立的有限元模型,能够较好地反映颈椎曲度变化对椎间盘应力的影响,可以用来研究颈椎病预防及治疗措施的有效性。     

颈椎椎体间融合器在颈椎病外科治疗中的应用

目的探讨应用颈椎椎体间融合器治疗脊髓型颈椎病的临床疗效。方法回顾性总结分析我院2002年3月~2005年2月间应用颈椎椎体间融合器治疗的38例脊髓型颈椎病患者的临床及影像学资料,观察椎体间隙高度、颈椎生理曲度及融合情况。结果平均随访10个月时,36例获得骨性融合,融合率达95%,优良率达87%,颈椎生理曲度及融合节段的椎间隙高度恢复及维持满意。结论颈椎椎体间融合器应用能使融合节段获得即刻的稳定性,恢复并维持颈椎生理曲度及融合节段的椎间隙高度,是治疗脊髓型颈椎病的有效方法。     

红外偏振光联合微波治疗神经根型颈椎病的疗效分析

目的 分析红外偏振光联合微波治疗神经根型颈椎病的临床效果.方法 选择本院2017年3月～2019年9月收治的神经根型颈椎病患者116例,随机分为常规组和实验组各58例.常规组给予曲度牵引进联合微波治疗,实验组在曲度牵引基础上给予红外偏振光联合微波治疗.记录治疗后患者的疼痛情况以及颈椎生理曲度,比较两组患者的治疗效果.结...     

颈椎手法配合局部推拿治疗上肢疾病的临床研究

目的 研究上肢常见疾病(肩周炎、肱骨外上髁炎、弹响指)与颈椎关节失衡的关系,观察颈椎小关节整复治疗上肢常见疾病的临床疗效.方法 采用临床随机方法,将被临床确诊为上述疾病的患者随机分为试验组和对照组,试验组采用颈椎小关节整复治疗;对照组采用常规按摩治疗.结果 试验组疗效明显优于对照组(试验组肩周炎总有效率为95.8%,肱骨外上髁炎为97.2%、弹响指为96.7%;对照组分别为75%,80.6%,76.7%).结论 上肢常见疾病与颈椎有关,纠正颈椎关节错位,调整颈椎曲度,恢复颈椎力学结构平衡,是治疗上肢常见疾病的关键.     

颈前路重建下颈椎稳定性的基础与临床研究进展

颈椎创伤性不稳及退变性不稳在临床上十分常见,病理改变及幄床表现相差甚大。本文综述了颈椎前路减压植骨钢板固定融合术系列研究,探讨治疗下颈椎不稳、修复重建颈椎生理曲度、增加稳定性的措施。     

Correlation between cervical spine sagittal alignment and clinical outcome after anterior cervical discectomy and fusion

Studies have shown that maintenance of lordosis improves outcomes after anterior cervical discectomy and fusion (ACDF). The relationship between maintenance or restoration of lordosis after ACDF and health-related quality of life (HRQOL) measures has not been evaluated. Preoperative and 2-year postoperative cervical lordosis (C2-C7) and segmental lordosis were measured from upright lateral cervical spine radiographs in patients who had ACDF. Data on the Neck Disability Index (NDI), Short- Form-36 Physical Composite Summary Score, arm, and neck pain scores were also collected. Paired t-tests were used to compare preoperative and 2-year postoperative radiographic measures and HRQOL measures. Receiver operating characteristic curves were constructed to identify sagittal parameters that predict achievement of a Minimum Clinically Important Difference (MCID) in outcome measures. One hundred one patients (75 female; mean age, 52 years) were included. There was improvement in all HRQOL measures from preoperative to 2 years postoperative. There was no significant difference in preoperative and 2-year postoperative sagittal alignment. Receiver operating characteristic curve analysis showed that a postoperative cervical lordosis of at least 6° predicted achievement of MCID for NDI (8 point change in NDI). This suggests that maintenance or restoration of overall cervical lordosis is important in achieving a successful result after ACDF.     

The sagittal profile of the cervical and lumbosacral spine in Scheuermann thoracic kyphosis

The sagittal profiles of the cervical and lumbar spine have not been studied in Scheuermann kyphosis. The purpose of this study was to investigate these profiles. Standing lateral radiographs of the spine in 34 children with Scheuermann kyphosis were reviewed. Cervical lordosis, lumbar lordosis, thoracic kyphosis, sagittal vertebral axis, and sacral inclination were measured. The relations between these variables were explored using the Pearson correlation. The average patient age was 15.5 +/- 1.8 years, thoracic kyphosis was 65 degrees +/- 12 degrees, lumbar lordosis 71 degrees +/- 13 degrees, and cervical lordosis 4 degrees +/- 15 degrees (Cobb angle), and 9 degrees +/- 14 degrees (posterior vertebral body angle [PVBA]). No correlations were noted between cervical lordosis and thoracic kyphosis. Correlations were noted between cervical lordosis and lumbar lordosis (r2 = 0.17, Cobb angle; r2 = 0.16, PVBA) and between cervical lordosis and the residual sagittal difference (thoracic kyphosis minus lumbar lordosis; r2 = 0.32, p = 0.001 [Cobb angle], and r2 = 0.19, p = 0.01 [PVBA]). In Scheuermann kyphosis, the flexible cervical and lumbar spine is linked by the intermediate rigid thoracic segment. As the residual sagittal difference becomes more kyphotic, lordosis of the cervical spine increases as the patient strives to maintain a forward visual gaze.     

颈前路带锁钛板在脊髓型颈椎病手术中的应用

目的评价脊髓型颈椎病前路减压后应用带锁钛板内固定的价值。方法对51例脊髓型颈椎病患者采用前路减压、取自体髂骨植骨和颈椎带锁钛板内固定治疗。结果随访43例,平均随访时间2a,术后3个月植骨块获得骨性融合,颈椎椎间高度和生理曲度维持满意,感觉、肌力明显恢复,钛板及螺钉无松动及断裂现象。结论脊髓型颈椎病前路减压术后应用带锁钛板内固定能促使植骨块融合,有效地维持椎间高度和颈椎生理曲度,有较高的应用价值。     

Assessment of cervical lordosis in patients after discectomy and cervical fusion with cages]

BACKGROUND: The aim of this study was assessment of cervical lordosis in patients after spondylodesis using a cage. The main question was whether using the cage after discectomy improves cervical lordosis. MATERIAL AND METHOD: The clinical material consists of 117 patients treated in Department of Neuroorthopedics at STOCER Rehabilitation Center in 2001-2004. All patients underwent anterior cervical discectomy and fusion with Solis cage. In the studied patients' group we applied 177 implants. On the basis of x-ray pictures cervical lordosis was evaluated. RESULTS: Cervical lordosis (C2-C7) significantly increased (+4.6 degrees) after operation. CONCLUSIONS: Usage of cage for spondylodesis after discectomy, significantly increases cervical lordosis.     

Cervical malalignment after laminoplasty: relationship to deep extensor musculature of the cervical spine and neurological outcome

OBJECT: The goal of this study was to investigate the relationship between preservation of the insertion of the deep extensor musculature of the cervical spine at C-2 and postoperative cervical alignment, especially differences between cases involving male and female patients, as well as the relationship between the loss of cervical lordosis and neurological outcome after laminoplasty. METHODS: The authors reviewed the records of 50 patients who underwent laminoplasty to elevate the C-3 lamina with repair of the deep extensor musculature (Group A) and 31 patients who underwent laminoplasty by C-3 dome laminotomy or laminectomy (Group B). They compared the degree of cervical lordosis after laminoplasty with preoperative measurements. Neurological function at last follow-up was also compared with preoperative assessments. RESULTS: In Group A, the mean values for pre- and postoperative cervical lordosis were 14.5 and 10.9 degrees, respectively (p > 0.18). In female patients, however, the pre- and postoperative means were 14.4 and 3.7 degrees, respectively (p < 0.004). In Group B, the overall means for pre- and postoperative cervical lordosis were 17.3 and 19.1 degrees, respectively (p > 0.48); the corresponding means for female patients were 15.0 and 14.1 degrees (p > 0.83). The mean percentages of neurological recovery were 54.1% in Group A and 54.8% in Group B. CONCLUSIONS: Preservation of the insertion of the deep extensor musculature to the C-2 spinous process prevented significant changes in cervical alignment after laminoplasty, even among female patients. Neurological recovery was not affected by the loss of cervical lordosis.     

肩胛肌筋膜炎软组织张力与颈椎生理曲度改变相关性探讨

目的：探讨肩胛肌筋膜炎患者颈椎曲度改变与软组织张力之间的相关性。方法：2012年2月至2012年12月门诊确诊肩胛肌筋膜炎患者29例,男10例,女19例;年龄22~40岁,平均27．77岁。常规拍摄颈椎正侧位X线片,并采用Borden测量法对颈椎生理曲度进行测量,用软组织张力仪测量患者痛点张力。最后对上述数值进行统计分析。结果：29例肩胛肌筋膜炎患者的侧位X线表现：颈椎生理曲度正常者9例,颈椎生理曲度减小者18例,颈曲颈椎生理曲度增大者2例。颈椎生理曲度改变D值（Y）对软组织张力位移D0.5kg（X）的回归方程Y=-15．069＋3．673X。结论：颈椎生理曲度改变与软组织张力之间具有相关性,可用线性回归方程表示。随着软组织张力的增加,颈椎生理曲度有减小的趋势。     

Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy.

Seventy-five patients who underwent surgical treatment for cervical spondylotic myelopathy were evaluated with respect to the operative procedure performed and their outcome. Forty patients underwent a laminectomy plus dentate ligament section (DLS), 18 underwent laminectomy alone, and 17 underwent an anterior cervical decompression and fusion (ACDF). The patients were evaluated postoperatively for both stability and for neurologic outcome using a modification of the Japanese Orthopaedic Association Assessment Scale. Functional improvement occurred in all but one patient in the laminectomy plus DLS group. The average improvement was 3.1 +/- 1.5 points in this group; whereas the average improvement in the laminectomy and the ACDF groups was 2.7 +/- 2.0 and 3.0 +/- 2.0 points respectively. All of the patients who improved substantially (greater than or equal to 6 points) in the laminectomy plus DLS and the laminectomy alone groups had normal cervical spine contours (lordosis). The remainder had either a normal lordosis or no curve (no kyphosis or lordosis). All patients in the ACDF group had either a straight spine or a cervical kyphosis. These factors implicate spine curvature, in addition to choice of operation, as factors which are important in outcome determination. No problems with instability occurred in either the laminectomy or the laminectomy plus DLS group. Two patients incurred problems with stability in the ACDF group. Both required reoperation. In addition, four patients in this group who initially improved, subsequently deteriorated. Six patients in the laminectomy plus DLS group had a several day febrile episode related to an aseptic meningitis process. Laminectomy plus DLS is a safe and efficacious alternative to laminectomy for the treatment of cervical spondylotic myelopathy. The data presented here suggests that myelopathic patients with a cervical kyphosis are best treated with an ACDF and that patients with a normal cervical lordosis are best treated with a posterior approach. Although some selected patients may benefit from DLS, no criteria are available which differentiate this small subset of patients.