CAJ | 학술논문

目的探讨颈椎曲度和活动度的测量参数及影响因素.方法回顾性分析2012年1月至2013年6月,212位正常志愿者的颈椎标准侧位、前屈位、后伸位X线片,男84位,女128位;年龄20～79岁,以10年为一组,分成6组;颈椎间盘退变程度依据颈椎9分法,分为4组.影像资料由3名脊柱外科医生分3次运用Mimics软件测量.测量参数包括C2～C7曲度及椎间各节段和整体活动度.对颈椎曲度和整体活动度的关系进行Pearson相关性分析,对年龄、性别和间盘退变三个因素进行多重线性回归分析.组内相关系数(ICG)评估测量者组内和组间一致性.结果 C2～C7曲度为21.40°±12.15°,C2～C7整体活动度为63.59°±15.37°.性别对颈椎曲度的影响有统计学意义(回归系数=-2.472,P＜0.05).性别和年龄两因素对颈椎整体活动度的影响有统计学意义(回归系数=3.863和-6.463,P＜0.05).性别对C2,3、C5,6两个节段活动度的影响有统计学意义;年龄对C2～C7所有五个节段活动度的影响有统计学意义;间盘退变对C4,5、C5,6和C6,7三个节段活动度的影响有统计学意义.颈椎曲度与颈椎整体及后伸活动度无明显相关性(r=-0.106和0.215,P＞0.05),但与前屈活动度呈负相关(r=-0.401,P＜0.05).颈椎曲度、整体活动度和节段活动度的测量结果均具有很高的组内一致性(ICC=0.97,0.96～0.97; ICC=0.91,0.90～0.92;ICC=0.89,0.87～0.91)和组间一致性(ICC=0.94,0.92～0.95;ICC=0.89,0.86～0.91;ICC=0.83,0.79～0.86).结论性别是颈椎曲度的影响因素,性别和年龄两因素是颈椎整体活动度的影响因素,性别、年龄和间盘退变程度是颈椎节段活动度的影响因素.
목적 탐토경추곡도화활동도적측량삼수급영향인소.방법 회고성분석2012년1월지2013년6월,212위정상지원자적경추표준측위、전굴위、후신위X선편,남84위,녀128위;년령20～79세,이10년위일조,분성6조;경추간반퇴변정도의거경추9분법,분위4조.영상자료유3명척주외과의생분3차운용Mimics연건측량.측량삼수포괄C2～C7곡도급추간각절단화정체활동도.대경추곡도화정체활동도적관계진행Pearson상관성분석,대년령、성별화간반퇴변삼개인소진행다중선성회귀분석.조내상관계수(ICG)평고측량자조내화조간일치성.결과 C2～C7곡도위21.40°±12.15°,C2～C7정체활동도위63.59°±15.37°.성별대경추곡도적영향유통계학의의(회귀계수=-2.472,P＜0.05).성별화년령량인소대경추정체활동도적영향유통계학의의(회귀계수=3.863화-6.463,P＜0.05).성별대C2,3、C5,6량개절단활동도적영향유통계학의의;년령대C2～C7소유오개절단활동도적영향유통계학의의;간반퇴변대C4,5、C5,6화C6,7삼개절단활동도적영향유통계학의의.경추곡도여경추정체급후신활동도무명현상관성(r=-0.106화0.215,P＞0.05),단여전굴활동도정부상관(r=-0.401,P＜0.05).경추곡도、정체활동도화절단활동도적측량결과균구유흔고적조내일치성(ICC=0.97,0.96～0.97; ICC=0.91,0.90～0.92;ICC=0.89,0.87～0.91)화조간일치성(ICC=0.94,0.92～0.95;ICC=0.89,0.86～0.91;ICC=0.83,0.79～0.86).결론 성별시경추곡도적영향인소,성별화년령량인소시경추정체활동도적영향인소,성별、년령화간반퇴변정도시경추절단활동도적영향인소.
Objective To establish standard parameters of cervical alignment and cervical range of motion(ROM) in asymptomatic population,and to explore the influential factors such as age,sex and cervical disc degeneration.Methods The cervical standard lateral,flexion and extension plain radiographs of 212 asymptomatic volunteers were analyzed retrospectively.The volunteers,including 128 females and 84 males with ages ranging from 20 to 79 years,were divided into 6 groups from 3rd to 8th decade of life and were divided into 4 groups based on the scoring system of cervical disc degeneration.These plain films were blindly measured by 3 spine surgeons with Mimics software,and each spine surgeon mcasured them for 3 times.Several parameters,including C2-C7 cervical alignment,total ROM,flexion ROM,extension ROM and segmental ROM were measured.The score of disc degeneration were assessed from C2-C3 to C6-C7.Pearson correlation analyses was used to quantify the relation between cervical alignment and total ROM.Multiple linear regression analyses were required to account for influential factors.Inter-and intrarater correlation coefficient was analyzed.Results The C2-C7 cervical alignment was 21.40°± 12.15°,and the total ROM was 63.59°± 15.37°.Sex had a significant impact on the cervical alignment (regression coefficient was-2.472,P ＜ 0.05).Both sex and age had significant impacts on the total ROM (regression coefficient was 3.863 and-6.463 respectively,P ＜ 0.05).Sex had a significant impact on C2,3 and C5,6 segmental ROM; age had a significant impact on all of the five segmental ROM from C2,3 to C6,7; cervical disc degeneration had a significant impact on the C4-5,C5-6 and C6-7 segmental ROM.The cervical alignment had no significant association with both of the extension and total ROM (r=-0.106 and 0.215,respectively,P ＞ 0.05),but had a significantly negative association with flexion angle (r=-0.401,P＜ 0.05).The measurement of cervical alignment,total ROM and segmental ROM showed excellent intra-rater agreement and excellent inter-rater agreement.Conclusion Sex is an influential factor of the cervical alignment.Sex and age are two influential factors of the total ROM.Sex,age and cervical disc degeneration are influential factors of the segmental ROM.The cervical alignments do not have an impact on total ROM.