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中华损伤与修复杂志(电子版) ›› 2024, Vol. 19 ›› Issue (05) : 371 -378. doi: 10.3877/cma.j.issn.1673-9450.2024.05.001

论著

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
王典1, 刘双赫2, 曾峥2,()   
  1. 1. 100070 首都医科大学附属北京天坛医院骨科(王典现在 100029 首都医科大学附属北京安贞医院骨科)
    2. 100070 首都医科大学附属北京天坛医院骨科
  • 收稿日期:2024-04-07 出版日期:2024-10-01
  • 通信作者: 曾峥
  • 基金资助:
    北京市卫生健康委高层次公共卫生技术人才学科骨干(2022-3-049)

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

Dian Wang1, Shuanghe Liu2, Zheng Zeng2,()   

  1. 1. Department of Orthopaedics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China (Wang Dian now in Department of Orthopaedics, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China)
    2. Department of Orthopaedics, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
  • Received:2024-04-07 Published:2024-10-01
  • Corresponding author: Zheng Zeng
引用本文:

王典, 刘双赫, 曾峥. 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[J]. 中华损伤与修复杂志(电子版), 2024, 19(05): 371-378.

Dian Wang, Shuanghe Liu, Zheng Zeng. Self-controlled cohort study of influence on muscular function changes after shoulder arthroscopy on cervical spine morphology and sagittal parameters[J]. Chinese Journal of Injury Repair and Wound Healing(Electronic Edition), 2024, 19(05): 371-378.

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。

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.

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
表2 影响上颈椎曲度的多重线性回归分析
表3 影响下颈椎曲度的多重线性回归分析
表4 影响颈椎顺列形态的多重线性回归分析
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