| Objective:To measure and analysis the parameters in the sagittal alignment of the upper cervical regions,the lower cervical regions and upper thoracic regions of the Lenke type 1 adolescent idiopathic scoliosis.Provide relevant reference for the clinical treatment and prediction of Lenke type 1 AIS.Methods:Retrospective analysis of patients with Lenke type 1 AIS who were treated at the center between January 2017 and January 2019.Exclusion criteria:(1)previous surgical history of spinal trauma or other related parameters;(2)on-standard full-length radiographs,poor quality;(3)spinal sequence diseases involving cervical and upper thoracic segments.Patients were divided into cervical lordosis group(CL>+5°),cervical straight group(-5°<CL<+5°),and cervical kyphosis group(CL<-5°)according to CL value.Measurements on the full-length lateral X-ray of the spine:cervical lordosis(CL),upper cervical sagittal Cobb angle(C1-C2 angle),lower cervical sagittal Cobb angle(C3-C7 angle),upper thoracic sagittal Cobb angle(T1-T3 angle),cervical sagittal vertical axis(C SVA),thoracic kyphosis(thoracic kyphosis,TK).The single-sample t-test was used to compare the measured imaging parameters with the previous literature parameters.Different CL groups,comparison between groups,prior variance homogeneity test:those who conform to the normal distribution and homogeneity of variance,use the one-way analysis of variance test to verify the significance,and those who have differences will further compare the SNK method.The correlation between the imaging parameters was analyzed by Pearson correlation(two sides).The difference was statistically significant at P<0.05.Results:Total of 34 patients with Lenke type 1 AIS were included in the study,including 3 males and 31 females,aged 10-17 years(15±1.38 years).34 patients with Lenke type 1 AIS:Cobb angle of the sagittal alignment of the upper cervical(C1-C2 angle)21.38°±7.10±,Cobb angle of the sagittal alignment of the lower cervical(C3-C7 angle)-5.35°±11.13°,C2-C7 SVA-17.92±10.20mm,the upper thoracic sagittal Cobb angle(T1-T3 angle)7.78±3.97°,TK 25.18°±11.15° The cervical lordosis angle(CL)averaged-5.42°±12.67°.The Cobb angle of the sagittal alignment of the upper cervical(C1-C2 angle),the Cobb angle of the sagittal alignmen of the lower cervical(C3-C7 angle),and the Cobb angle of the sagittal alignmen of the upper thoracic(T1-T3 angle)were compared with the previous literature using a one-sample t test.Distribution,sample size,and age were not statistically significant.Taking the mean values of the previous reference data as the standard of the normal population,the Cobb angle(C1-C2 angle)of the sagittal alignmen of the cervical segment and the Cobb angle of the sagittal alignmen of the lower cervical(C3-C7 angle)of the Lenke type 1 AIS patients and the normal population were obtained.Comparing the upper thoracic sagittal Cobb angle(T1-T3 angle),we found that the mean value of the sagittal Cobb angle(C1-C2 angle)and the sagittal alignmen Cobb angle(C3-C7 angle)of the upper cervical segment are smaller than that of men and women.In the normal population reported in the literature,there was no statistically significant difference in the Cobb angle(T1-T3 angle)between the upper thoracic sagittal alignmen and the previous references(P>0.05).In 34 patients with Lenke type 1 AIS,8 patients(23.53%)had cervical lordosis,8 patients(23.53%)had cervical spine straightening group,and 18 patients(52.94%)had cervical kyphosis group.Cobb angle(C1-C2 angle)in the sagittal plane of the upper cervical segment,Cobb angle(C3-C7 angle)in the sagittal alignmen of the lower cervical segment,C SVA and TK angles in different CL groups;cervical kyphosis group and cervical straightening group in AIS patients(P=0.000),between the cervical lordosis group and the cervical vertebrae straightening group(P=0.000),the sagittal Cobb angle(C1-C2 angle)of the upper cervical segment was statistically significant(P<0.05);the cervical kyphosis group and Cervical vertebrae straightening group(P=0.000),cervical lordosis group and cervical vertebrae straightening group(P=0.000)cervical kyphosis group and cervical lordosis group(P=0.041)lower cervical sagittal Cobb angle C3-C7 The difference was statistically significant(P<0.05);cervical lordosis and cervical vertebrae straightening group,cervical lordosis group and cervical kyphosis group,cervical kyphosis group and cervical vertebrae straightening group,C SVA,TK was significantly different(P<0.05).The mean value of TK in the cervical kyphosis straightening and kyphosis group decreased in the three groups;however,the mean value of |C SVA| in the cervical kyphosis,straightening and kyphosis group was between the three groups.The order of the Cobb angle of the sagittal alignmen of the lower cervical(C3-C7 angle)is positive in the lordosis and negative in the kyphosis.It is reduced in the anterior convex group and the straightening group of the cervical vertebrae.The kyphosis angle of the kyphosis group is increased;the Cobb angle of the sagittal plane of the upper cervical segment(C1-C2 angle)is reduced in the cervical kyphosis kurtosis group and the straightening group,and the straightening group and the kyphosis group are Increased,and there is no statistical significance between the anterior convex group and the kyphosis group.In 34 patients with Lenke type 1 AIS,the Cobb angle of the sagittal plane of the upper cervical(C1-C2 angle)was moderately negatively correlated with the Cobb angle of the sagittal plane of the lower cervical(C3-C7 angle)(r=-0.559,P=0.001).There was no significant correlation between the sabboid Cobb angle(CI-C2 angle)and C SVA(P=0.531),the sagittal Cobb angle of the lower cervical(C3-C7 angle)and the sagittal Cobb angle of the upper thoracic(T1-T3).The angle(r=0.533,P=0.001)showed a moderate positive correlation,and the sagittal Cobb angle(C3-C7 angle)of the lower cervical was positively correlated with the TK angle(r=0.578,P=0.003).There was a significant positive correlation between the Cobb angle(C1-C2 angle)of the sagittal plane of the upper cervical segment and the Cobb angle of the sagittal plane of the lower cervical(C3-C7 angle)between the different CL groups:anterior convex group and straightening group(r=0.531,P=0.034),the Cobb angle(C1-C2 angle)of the sagittal plane of the upper cervical segment and the Cobb angle of the sagittal plane of the lower cervical(C3-C7 angle)were significantly negatively correlated(r=-0.815,P=0.000).).A case of cervical sagittal imbalance was found.The incidence rate was 2.94%.Conclusion(s):The proportion of cervical kyphosis was higher in Lenke type 1 AIS patients(52.94%).Compared with the normal population,patients with Lenke type 1 AIS had a C1-C2 sagittal Cobb angle and a C3-C7 sagittal Cobb angle that were smaller than the normal population reported in the literature,but the T1-T3 sagittal Cobb angle.It is about the same size as the normal population.In patients with anterior convex and straightening groups,the body regulates the balance of the sagittal of the cervical spine by reducing the Cobb angle of the C1-C2 sagittal and the Cobb angle of the C3-C7 sagittal to maintain the skull-cervical balance and anterior gaze.Balance;in the kyphosis group,the body adjusts the sagittal plane sequence balance by increasing the C1-C2 sagittal Cobb angle and the kyphosis C3-C7 sagittal Cobb angle to maintain the skull-cervical balance and anterior The gaze balance;in the Lenke type 1 AIS patients,the T1-T3 sagittal Cobb angle contributes less to the regulation of the sagittal balance of the cervical spine.The stress generated by the thoracic deformity is transmitted to the cervical vertebra sequence like the cervical pedicle. |
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