肩关节镜术后肌肉功能改变对颈椎形态及矢状面参数影响的自身前后对照队列研究

doi:10.3877/cma.j.issn.1673-9450.2024.05.001

目的

评估肩关节镜患者术后颈肩部肌肉功能改变对颈椎矢状面参数及顺列形态影响。

方法

连续纳入2022年10月至2023年12月首都医科大学附属北京天坛医院骨科收治的68例肩峰撞击综合征患者，评估患者一般情况[性别、年龄、身高、体重、体质量指数(BMI)]，评估术前、术后3 d、术后6周生活质量评分[颈部、肩部视觉模拟评分(VAS)]、影像学参数(上颈椎曲度、下颈椎曲度、C2-C7矢状面垂直轴、T1倾斜角、颈椎顺列形态)和肌肉功能指数[头夹肌、上斜方肌和胸锁乳突肌屈曲放松比(FRR)、共同收缩比(CCR)]，评估术前、术后3 d和术后6周生活质量评分、颈椎影像学参数和肌肉功能指数差异，评估生活质量评分、颈椎影像学参数和肌肉功能指数相关性，多因素回归分析上颈椎曲度、下颈椎曲度和颈椎顺列形态影响因素。

结果

术前、术后3 d和术后6周生活质量评分、颈椎影像学参数和肌肉功能指数差异有统计学意义(P<0.05)；多因素回归分析提示颈部VAS评分(β＝-0.215，P<0.01)、下颈椎曲度(β＝-0.160，P<0.05)显著负向预测上颈椎曲度；T1倾斜角(β＝-0.633，P<0.01)和后伸CCR(β＝-0.124，P<0.05)显著负向预测下颈椎曲度，颈部视觉模拟评分(β＝0.108，P<0.05)、C2-C7矢状面垂直轴(β＝0.319，P<0.01)和上斜方肌屈曲FRR(β＝0.041，P<0.01)显著正向预测下颈椎曲度；后伸CCR(β＝-1.325，P<0.01)显著负向预测颈椎顺列形态，颈部VAS评分(β＝0.060，P<0.05)、下颈椎曲度(β＝0.032，P<0.01)显著正向预测颈椎顺列形态。

结论

颈部疼痛和下颈椎曲度是上颈椎曲度独立影响因素；颈部疼痛、C2-C7矢状面垂直轴、T1倾斜角、上斜方肌舒缩功能和颈部肌肉协同性是下颈椎曲度独立影响因素；颈部疼痛、下颈椎曲度、颈部肌肉协同性是颈椎顺列形态的独立影响因素；颈肩部肌肉功能改变联合C2-C7矢状面垂直轴和T1倾斜角，影响下颈椎曲度，继而影响上颈椎曲度。

关键词: 关节镜, 颈椎影像学参数, 脊柱后凸, 肌肉功能, 表面肌电图

Objective

To evaluate the effect of muscular functions on the cervical sagittal parameters and alignment after shoulder arthroscopy.

Methods

From October 2022 to December 2023, 68 patients with subacromial impingment syndrome admitted in Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University. The general conditions (gender, age, height, weight, body mass index) of the subjects were evaluated. The quality of life score (VAS of neck and shoulder), imaging parameters (upper cervical curvature, lower cervical curvature, C2-C7 sagittal vertical axis, T1-Slope, cervical alignment) and muscle function index (flexion-relaxation ratio of splenius capitis, upper trapezius and sternocleidomastoid, co-contraction ratio during flexion and extension) were evaluated pre-operation, 3 days and 6 weeks post-operation. The differences of quality of life score, cervical sagittal parameters and muscle function index were evaluated, and the correlation between quality of life score, cervical imaging parameters and muscle function index were evaluated. Multivariate regression analysis was used to analyze the influencing factors of upper cervical curvature, lower cervical curvature and cervical alignment.

Results

There were significant differences in quality of life score, ssagittal parameters and muscular function of cervical spine pre-operation, 3 days and 6 weeks post-operation (P< 0.05). Multivariate regression analysis showed that neck visual analogue scale (β=-0.215, P<0.01) and lower cervical curvature (β=-0.160, P<0.05) were significantly negative predictors of upper cervical curvature. T1-Slope (β=-0.633, P<0.01) and co-contraction ratio during extension (β=-0.124, P<0.05) significantly negatively predicted lower cervical curvature, neck VAS(β=0.108, P<0.05), and C2-C7 sagittal vertical axis (β=0.319, P<0.01) and FRR of upper trapezius (β=0.041, P<0.01) significantly positively predicted lower cervical curvature. The co-contraction ratio during extension (β=-1.325, P<0.01) negatively predicted the alignment of the cervical spine, and the neck VAS(β=0.060, P<0.05) and lower cervical curvature (β=0.032, P<0.01) positively predicted the alignment of the cervical spine.

Conclusions

Neck pain and lower cervical curvature are independent influence factors of upper cervical curvature. Neck pain, C2-C7 sagittal vertical axis, T1-Slope, flexion-relaxation ratio of upper trapeziu and co-contraction ratio during extension were independent influence factors of lower cervical curvature. Neck pain, lower cervical curvature and co-contraction ratio during extension are independent influence factors of cervical alignment.The changes of neck and shoulder muscle function combine with C2-C7 sagittal vertical axis and T1 tilt angle to affect lower cervical curvature, and then affecting upper cervical curvature.

Key words: Arthroscopes, Cervical spine sagittal parameters, Kyphosis, Muscular function, Surface electromyography

表1 患者生活质量评分、影像学参数与肌肉功能指数相关性分析

项目	VAS_N	VAS_S	C0-C2曲度	C2-C7曲度	C2-C7 SVA	T1S	颈椎顺列形态	FRR_SPL	FRR_UTr	FRR_SCM	CCR_NF	CCR_EN
VAS_N	1	0.024	-0.310^b	0.153^a	-0.018	-0.004	0.224^b	0.074^a	0.192^a	0.161^a	-0.255^b	-0.231^b
VAS_S		1	-0.030	0.003^a	0.113	0.065	-0.110	-0.087	-0.127^a	0.041	0.346^b	0.353^b
C0-C2曲度			1	-0.158^a	-0.102	-0.031	-0.090	0.012	-0.243^b	-0.146^a	0.134	0.029
C2-C7曲度				1	0.167^a	-0.575^b	0.473^b	0.118^a	0.065	-0.157^a	-0.031	-0.141^a
C2-C7 SVA					1	0.162^a	-0.105	0.074	-0.024	-0.089	0.081	0.199^b
T1S						1	-0.301^b	0.041	0.157^a	0.140^a	-0.107	0.074
颈椎顺列形态							1	0.204	-0.124	-0.004	-0.182^b	-0.357^b
FRR_SPL								1	0.317^b	-0.023	-0.256^b	-0.022
FRR_UTr									1	0.304^b	-0.115	-0.221^b
FRR_SCM										1	0.163^a	-0.148^a
CCR_NF											1	0.311^b
CCR_EN												1

表1 患者生活质量评分、影像学参数与肌肉功能指数相关性分析

项目	VAS_N	VAS_S	C0-C2曲度	C2-C7曲度	C2-C7 SVA	T1S	颈椎顺列形态	FRR_SPL	FRR_UTr	FRR_SCM	CCR_NF	CCR_EN
VAS_N	1	0.024	-0.310^b	0.153^a	-0.018	-0.004	0.224^b	0.074^a	0.192^a	0.161^a	-0.255^b	-0.231^b
VAS_S		1	-0.030	0.003^a	0.113	0.065	-0.110	-0.087	-0.127^a	0.041	0.346^b	0.353^b
C0-C2曲度			1	-0.158^a	-0.102	-0.031	-0.090	0.012	-0.243^b	-0.146^a	0.134	0.029
C2-C7曲度				1	0.167^a	-0.575^b	0.473^b	0.118^a	0.065	-0.157^a	-0.031	-0.141^a
C2-C7 SVA					1	0.162^a	-0.105	0.074	-0.024	-0.089	0.081	0.199^b
T1S						1	-0.301^b	0.041	0.157^a	0.140^a	-0.107	0.074
颈椎顺列形态							1	0.204	-0.124	-0.004	-0.182^b	-0.357^b
FRR_SPL								1	0.317^b	-0.023	-0.256^b	-0.022
FRR_UTr									1	0.304^b	-0.115	-0.221^b
FRR_SCM										1	0.163^a	-0.148^a
CCR_NF											1	0.311^b
CCR_EN												1

表2 影响上颈椎曲度的多重线性回归分析

参数	B	β	t值	P值	F值	调整R²
VAS_N	-0.752	-0.215	-3.089	0.002	5.285	0.781
C2-C7曲度	-0.080	-0.160	-2.301	0.022
FRR_UTr	-0.280	-0.076	-0.749	0.455
FRR_SCM	-0.136	-0.058	-0.577	0.565

表2 影响上颈椎曲度的多重线性回归分析

参数	B	β	t值	P值	F值	调整R²
VAS_N	-0.752	-0.215	-3.089	0.002	5.285	0.781
C2-C7曲度	-0.080	-0.160	-2.301	0.022
FRR_UTr	-0.280	-0.076	-0.749	0.455
FRR_SCM	-0.136	-0.058	-0.577	0.565

表3 影响下颈椎曲度的多重线性回归分析

参数	B	β	t值	P值	F值	调整R²
VAS_N	0.753	0.108	1.955	0.047	5.285	0.745
VAS_S	0.422	0.072	1.284	0.201
C0-C2曲度	-0.193	-0.097	-1.763	0.079
C2-C7 SVA	0.471	0.319	5.488	0.000
T1-Slope	-0.980	-0.633	-11.449	0.000
FRR_UTr	0.305	0.041	0.689	0.002
CCR_E	-7.584	-0.124	-2.075	0.039

表3 影响下颈椎曲度的多重线性回归分析

参数	B	β	t值	P值	F值	调整R²
VAS_N	0.753	0.108	1.955	0.047	5.285	0.745
VAS_S	0.422	0.072	1.284	0.201
C0-C2曲度	-0.193	-0.097	-1.763	0.079
C2-C7 SVA	0.471	0.319	5.488	0.000
T1-Slope	-0.980	-0.633	-11.449	0.000
FRR_UTr	0.305	0.041	0.689	0.002
CCR_E	-7.584	-0.124	-2.075	0.039

表4 影响颈椎顺列形态的多重线性回归分析

参数	B	β	t值	P值	F值	调整R²
VAS_N	0.060	0.104	1.702	0.032	21.317	0.334
C2-C7曲度	0.032	0.379	5.308	0.000
T1-Slope	-0.016	-0.124	-1.732	0.085
CCR_F	-0.341	-0.099	-1.604	0.110
CCR_E	-1.325	-0.261	-4.360	0.000

表4 影响颈椎顺列形态的多重线性回归分析

参数	B	β	t值	P值	F值	调整R²
VAS_N	0.060	0.104	1.702	0.032	21.317	0.334
C2-C7曲度	0.032	0.379	5.308	0.000
T1-Slope	-0.016	-0.124	-1.732	0.085
CCR_F	-0.341	-0.099	-1.604	0.110
CCR_E	-1.325	-0.261	-4.360	0.000

[1]	Scheer JK，Lau D，Ames CP.Sagittal balance of the cervical spine[J].J Orthop Surg (Hong Kong)，2021，29(1_suppl): 23094990211024454.
[2]	Ohara A，Miyamoto K，Naganawa T，et al.Reliabilities of and correlations among five standard methods of assessing the sagittal alignment of the cervical spine[J].Spine(Phila Pa 1976)，2006，31(22)：2585-2591；discussion 2592.
[3]	Ao S，Liu Y，Wang Y，et al.Cervical kyphosis in asymptomatic populations: incidence, risk factors, and its relationship with health-related quality of life[J].J Orthop Surg Res，2019，14 (1)：322.
[4]	Ruangchainikom M, Daubs MD，Suzuki A，et al.Effect of cervical kyphotic deformity type on the motion characteristics and dynamic spinal cord compression[J].Spine(Phila Pa 1976)，2014，39(12): 932-938.
[5]	Patwardhan AG, Khayatzadeh S，Havey RM，et al.Cervical sagittal balance：a biomechanical perspective can help clinical practice[J].Eur Spine J，2018，27 (Suppl 1)：25-38.
[6]	Been E，Shefi S，Soudack M．Cervical lordosis：the effect of age and gender[J].Spine J，2017，17(6)：880-888.
[7]	Ding Y，Liu B，Qiao H，et al.Can knee flexion contracture affect cervical alignment and neck tension? A prospective self-controlled pilot study[J].Spine J，2020，20(2)：251-260.
[8]	Hattrup SJ，Cofield RH.Rotator cuff tears with cervical radiculopathy[J].J Shoulder Elbow Surg，2010，19(6)：937-943.
[9]	Chiou-Tan FY.Musculoskeletal mimics of cervical radiculopathy[J].Muscle Nerve，2022，66(1): 6-14.
[10]	Tan LA，Riew KD，Traynelis VC.Cervical spine deformity-part 1：biomechanics, radiographic parameters, and classification[J]. Neurosurgery，2017，81(2)：197-203.
[11]	Ketola S，Lehtinen J，Arnala I，et al.Does arthroscopic acromioplasty provide any additional value in the treatment of shoulder impingement syndrome？：a two-year randomised controlled trial[J].J Bone Joint Surg，2009，91(10): 1326-1334.
[12]	Thigpen CA，Shaffer MA，Gaunt BW，et al.The American society of shoulder and elbow therapists′consensus statement on rehabilitation following arthroscopic rotator cuff repair[J].J Shoulder Elbow Surg，2016，25(4)：521-535.
[13]	Le Huec JC，Thompson W，Mohsinaly Y，et al.Sagittal balance of the spine[J].Eur Spine J，2019，28(9)：1889-1905.
[14]	Wang D，Ding Y，Wu B，et al.Cervical extensor muscles play the role on malalignment of cervical spine：a case control study with surface electromyography assessment[J].Spine(Phila Pa 1976)，2021，46(2)：E73-E79.
[15]	Cheng CH，Lin KH，Wang JL.Co-contraction of cervical muscles during sagittal and coronal neck motions at different movement speeds[J].Eur J Appl Physiol，2008，103(6)：647-654.
[16]	Larsson B, Søgaard K，Rosendal L．Work related neck-shoulder pain：a review on magnitude，risk factors，biochemical characteristics，clinical picture and preventive interventions[J]. Best Pract Res Clin Rheumatol，2007，21(3)：447-463.
[17]	Scully WF, Wilson DJ，Parada SA，et al.Iatrogenic nerve injuries in shoulder surgery[J].J Am Acad Orthop Surg，2013，21(12): 717-726.
[18]	Ling FP，Chevillotte T，Leglise A，et al.Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review[J].Eur Spine J，2018，27(Suppl 1)：8-15.
[19]	Lee SH，Kim KT，Seo EM，et al.The influence of thoracic inlet alignment on the craniocervical sagittal balance in asymptomatic adults[J].J Spinal Disord Tech，2012，25 (2): E41-E47.
[20]	Mahmoud NF，Hassan KA，Abdelmajeed SF，et al.The relationship between forward head posture and neck pain：a systematic review and meta-analysis[J].Curr Rev Musculoskelet Med，2019，12 (4): 562-577.
[21]	Kocur P，Łochyński D．Female office workers with moderate neck pain have increased anterior positioning of the cervical spine and stiffness of upper trapezius myofascial tissue in sitting posture：response to letter to editor[J].PM R ，2020，12(10)：1061.
[22]	Scheer JK，Tang JA，Smith JS，et al.Cervical spine alignment，sagittal deformity，and clinical implications[J].J Neurosurg Spine，2013，19(2)：141-159.
[23]	An Y，Li J，Li Y，et al.Characteristics of modic changes in cervical kyphosis and their association with axial neck pain[J].J Pain Rese，2017，10：1657-1661.
[24]	Abelin-Genevois K．Sagittal balance of the spine[J].Orthop Traumatol Surg Res，2021，107 (1s): 102769.
[25]	李益，丁琛，何俊波，等．对颈椎椎旁肌脂肪浸润与颈椎病患者颈椎前路Hybrid术后矢状面平衡参数关系的分析[J].骨科临床与研究杂志，2023，8(2)：110-117.

[1]	纪小孟, 刘璠, 唐晓波, 卞为伟, 董佩龙, 刘振鲁. 两种手术方式治疗肩袖撕裂合并粘连性肩关节囊炎[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 561-567.
[2]	苏介茂, 齐岩松, 王永祥, 魏宝刚, 马秉贤, 张鹏飞, 魏兴华, 徐永胜. 关节镜手术在早中期膝骨关节炎治疗的应用进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(05): 646-652.
[3]	李程, 朱梁, 庞勇, 查国春, 仇尚, 孙伟, 冯硕. 侧侧缝合联合无结缝线桥技术治疗大型L型肩袖撕裂[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 301-306.
[4]	肖志满, 庄锡琪, 龚煜. 关节镜下Lasso-loop Gould术式治疗踝关节外侧不稳定的早期疗效[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 280-284.
[5]	蔡雨琦, 史尉利, 陶立元, 曹建夫, 崔国庆, 杨渝平. 支持带松解联合外侧成形治疗髌骨外侧过度挤压综合征[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 186-192.
[6]	韩伟峰, 王典, 陈艺丹, 曾峥. 关节镜下半月板成形术与康复训练治疗中年退行性内侧半月板撕裂的疗效比较[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(02): 134-140.
[7]	曲洋, 蒋浩然, 邢博涵, 张蒙, 张培训. 肩袖损伤的治疗进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 289-291.
[8]	冯亚飞, 唐诗添, 唐福宽, 周亮. 关节镜下mLSRS 技术及双排缝线桥技术治疗大型肩袖撕裂的疗效及预后分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 295-301.
[9]	王友健, 陶然, 陆跃, 马洪冬. 退行性中、小型肩袖撕裂两种临床治疗效果对比[J/OL]. 中华肩肘外科电子杂志, 2024, 12(04): 302-308.
[10]	王涵宇, 王蕾. Bankart损伤的关节镜下修复进展[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 262-270.
[11]	郁凯, 曾保起, 杨剑, 杨杰, 张殿英, 孙凤. 全关节镜与切开手术治疗肩袖撕裂疗效比较的系统综述与Meta分析[J/OL]. 中华肩肘外科电子杂志, 2024, 12(03): 238-245.
[12]	唐晓俞, 邓凯文, 冯剑, 邹义源, 郑新波, 王小芃. 关节镜下V-Y结缝合方式与缝线桥技术修复中型肩袖损伤的比较[J/OL]. 中华肩肘外科电子杂志, 2024, 12(02): 107-114.
[13]	白云鹏, 孙卫兵, 王苗, 丁浩亮, 孙健. 肘关节镜桡侧腕短伸肌腱松解联合关节清理术治疗顽固性网球肘[J/OL]. 中华肩肘外科电子杂志, 2024, 12(02): 135-139.
[14]	李广峰, 李王, 尹志峰, 王思成, 张文薷, 彭勇, 杜暠, 曹中华, 张友忠, 刘仲祥, 刘望, 刘祥飞. 切开复位与全关节镜下空心钉内固定治疗Mutch II型肱骨大结节骨折疗效比较[J/OL]. 中华肩肘外科电子杂志, 2024, 12(01): 56-60.
[15]	刘胜锋, 陈云强. 不同强度改良强制性运动疗法对脑卒中患者上肢肌肉形态及表面肌电的影响[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(03): 224-229.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Self-controlled cohort study of influence on muscular function changes after shoulder arthroscopy on cervical spine morphology and sagittal parameters

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Self-controlled cohort study of influence on muscular function changes after shoulder arthroscopy on cervical spine morphology and sagittal parameters