| PART Ⅰ:COMEPARATIVE ANALYSIS OF MORPHOLOGICAL PARAMETERS OF CERVICAL SPINE INVOLVING ANKYLOSING SPONDYLITIS AND HEALTHY ObjectiveBy comparing the morphological features of cervical spine in patients with ankylosing spondylitis and normal adults,the feasibility and effectiveness of cervical morphological parameters(mandibular sternal angle α and mandibular sternal spacing d)were evaluated to guide the anterior cervical approach.MethodsThe imaging data of 45 patients with ankylosing spondylitis(AS)involving the cervical spine in the PACS imaging system from January 2010 to January 2019 in Linyi People’s Hospital were selected.The general condition,age of onset,and family history of the patients were recorded in detail.Waiting for the situation.The Cobb angle of the AS cervical vertebra was measured,with the reference value of the Cobb angle 21° of the normal person as the critical value,the flexion-type less than 21°(group A,n=25),and the straight-type larger than 21°(group B,n=20).At the same time,normal healthy volunteers were selected as the control group(group C,n=30).The mandibular sternal angle α and the mandibular sternal distance d under the X-ray film of the patient were measured respectively.The measurement method is shown in Fig.2.The statistical analysis of the group A and the group C,the group B and the group C were performed to observe the statistics.Learn the difference.Results1.There was no significant difference in gender,age and control group between flexion-type group A and straight-type group B(P>0.05).2.The mandibular sternal angle α was measured by cervical hyperextension.The flexion-type was significantly different from the control group(P<0.05);There was no significant difference between the straight-type and the control group(P>0.05),as shown in Tables 2 and 3.3.The mandibular sternal spacing d was measured by cervical hyperextension.The flexion-type and control group were statistically different(P<0.05);There was no significant difference between the straight-type and the control group(P>0.05),as shown in Table 2 and 3.ConclusionThe mandibular sternal angle and the mandibular sternal spacing of the AS patients with flexion-type cervical vertebrae was significantly lower than that of the normal healthy people.There was no significant difference in the distance between the mandibular sternal angle and the mandibular sternal spacing in AS patients with straight-type cervical vertebrae.Because the segment of the cervical spine in normal person can be treated with anterior long-segment fixation,we believe that AS patients of straight-type can be treated with anterior long-segment fixation,while patients with flexion-type AS may not be suitable for anterior long-segment internal fixation.Two cervical morphological parameters of mandibular sternal angle and mandibular sternal spacing have guiding the significance for the choice of anterior cervical approach in AS patients.PART Ⅱ: CORRELATION ANALYSIS OF CERVICAL MORPHOLOGICAL PARAMETERS IN PATIENTS WITH ANKYLOSING SPONDYLITIS AND CERVICAL SPINE FRACTURES WITH ANTERIOR CERVICAL LONG AND SHORT SEGMENTAL FIXATIONObjective Retrospective analysis of AS patients with cervical spine surgery,compare the differences of the cervical morphological parameters(mandibular sternal angle α and mandibular sternal spacing d)in cervical anterior long segmental fixation and anterior short segmental fixation.To verify the feasibility of cervical morphology parameters guiding cervical anterior approach,and define the range of cervical morphological parameters,so as to guide the choice of cervical anterior approach.Methods A retrospective analysis of 43 patients with ankylosing spondylitis complicated with cervical spine fractures and anterior surgery performed at the Linyi People’s Hospital from January 2003 to February 2019.All patients underwent fractures of the lower cervical spine.The fractures were classified according to Caron et al.: 31 cases of type A,9 cases of type C,and 3 cases of type D.All 43 patients had different degrees of spinal cord injury.According to Frankel classification: 5 cases were grade A,3 cases were grade B,17 cases were grade C,14 cases were grade D,and 4 cases were grade E.Short anterior segmental fixation(group A,n=23),20 males and 3 females,with an average age of 51.7±11.5 years;Long anterior segmental fixation(group B,n=20),male 15 For example,5 women,with an average age of 53.4 ± 9.4 years.The mandibular sternal angle α and the mandibular sternal spacing d in the A and B groups were measured and compared on the lateral X-ray films.If there is a difference,the critical value of α(interval value)is defined.Results After statistical analysis,there was no significant difference in gender and age between the two groups(P>0.05).There was a statistically significant difference in the degree of mandibular sternal angle between the two groups(P<0.05).The difference of mandibular sternal spacing d was statistically significant(P < 0.05).In group A,95% CI(20.9°,33.6°)of mandibular sternal angle α and 95% CI(33.1°,41.0°)of mandibular sternal angle α in group B.Group A CU=33.6°,Group B CL=33.1°,so patients with anterior short-segment surgery had a 95% chance of mandibular sternal angle α less than 33.6°,and patients with anterior long-segmental surgery had a 95% chance of mandibular sternal angle α greater than 33.1°,as shown in Figure 5.Conclusion Cervical morphological parameters(mandibular sternal angle α and mandibular sternal spacing d)are feasible to guide the anterior cervical approach.The intersection of the mandibular sternal angle α is around 33°,with 33° as the reference standard.For patients with AS and cervical fractures,the mandibular sternal angle α>33° can be considered for anterior long segment fixation,whereas if the mandibular sternal angle α <33 °,then we believe that because the narrow field is not suitable for the fixation of the anterior long segment,the anterior short segment internal fixation or posterior internal fixation should be selected as appropriate. |
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