| Objective: To study the changes of cervical sagittal parameters and clinical effects in different occipitocervical angle groups after fixation of craniocervical region.Methods: From January 2013 to August 2019,82 patients with complete imaging findings underwent posterior fixation of craniocervical region were analyzed retrospectively.The sagittal parameters of craniocervical region were recorded before and at the last follow-up: occipitocervical angle,C2-7 angle,C0-7 angle,C2-7 SVA,occipital external auditory canal axial angle(O-EA angle),nasopharynx narrowest airway space(n PAS),T1 tilt angle(T1s),neck tilt angle(NT),thoracic inlet angle(TIA).The clinical prognosis was evaluated by neck disability index(NDI)and Japanese Orthopedic Association score(JOA).The degree of dysphagia was evaluated by bazaz dysphagia grading system.The modified Borg dyspnea score was used to evaluate the dyspnea of the patients.The Pearson correlation coefficient was used to analyze the relationship among the sagittal parameters.The occipitocervical angle in the last follow-up was divided into < 10° group,10-20° group and > 20° group.Result: △Occipitocervical angle is negatively correlated with △C2-7 angle(r =-0.447,P <0.01),positively correlated with △C0-7 angle(r = 0.441,P <0.01),and positively correlated with △C2-7 SVA(r = 0.344,P <0.01),positively correlated with △O-EA angle(r = 0.233,P <0.05);△C2-7 angle positively correlated with △C0-7 angle(r = 0.579,P <0.01),△T1s is positively correlated(r = 0.339,P <0.01).There was no significant correlation between △occipitocervical angle and △JOA score and △NDI score.In the last follow-up,the sagittal parameters and clinical results of different occipitocervical angle groups were analyzed.The average value of C2-7 angle in the last follow-up was 34.75 ± 17.84° in < 10 group,20.40 ± 11.05° in10-20° group and 17.88 ± 13.07° in > 20 group.There was significant difference between 10-20° group and < 10° group(P < 0.05);there was significant difference between > 20° group and < 10° group(P < 0.05).In the last follow-up,the mean value of O-EA angle was 91.02 ± 6.63° in the < 10 ° group,98.17 ± 5.67° in the 10-20°group and 103.31 ± 6.85° in the > 20° group.There was significant difference in different occipitocervical angle groups(P < 0.05).The mean value of C2-7 SVA in the last follow-up was 4.97 ± 16.09 mm in group 10°,11.42 ± 14.08 mm in group 10-20°and 20.89 ± 16.24 mm in group > 20°.There was significant difference between group20° and group < 10°(P < 0.05).In the last follow-up,the mean value of JOA score was 13.86 ± 1.77 in < 10° group,15.46 ± 1.20 in 10-20° group and 14.00 ± 1.41 in >20° group.There was significant difference between the 10-20° group and the < 10°group(P < 0.05);there was significant difference between the > 20° group and the10-20° group(P < 0.05).In the last follow-up,the average NDI score was 9.65 ± 2.74 in < 10° group,7.61 ± 1.45 in 10-20° group and 9.47 ± 2.79 in > 20° group.There was significant difference between the 10-20° group and the < 10° group(P < 0.05).In the < 10° group,the incidence of dysphagia was 18.9%(7/37);in the 10-20° group,the incidence of dysphagia was 3.6%(1/28);in the > 20° group,the incidence of dysphagia was 11.8%(2/17).There was no significant difference in the incidence of dysphagia between different groups(P > 0.05).At the last follow-up,one patient had dyspnea after operation.The mean value of JOA before operation was 9.93 ± 2.45;the mean value of JOA during the last follow-up was 14.44 ± 1.68,which was statistically significant(P < 0.05).The average value of preoperative NDI was 19.30 ± 4.65,and the average value of the last follow-up was 8.91 ± 2.54(P < 0.05).Conclusion:(1)The clinical prognosis and neurological function of patients with craniocervical lesions can be improved after posterior fixation of craniocervical region;(2)In the last follow-up,the sagittal C2-7 angle,C0-7 angle,O-EA angle,C2-7 SVA and clinical function scores of different occipitocervical angle groups are different,and the C2-7 angle,O-EA angle and JOA scores in the occipitocervical angle group of 10-20° are better than those in the group of < 10° and > 20°;(3)If the occipitocervical angle is fixed in the over flexion position in the last follow-up,dyspnea may occur more easily;(4)When the occipitocervical angle is between10-20° in the last follow-up,the incidence of dysphagia is lower.It seems that it is a better choice to fix the occipitocervical angle in the 10-20° range. |
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