| 摘要: |
| 目的 探讨颈椎Pavlov比值对部队中青年人群颈椎退变和颈椎相关临床表现的影响。方法 收集2021年1月至8月间以“颈痛”为主诉且症状持续时间>3个月的18~40岁军人患者的人口学、影像学及临床资料。根据X线片测量数据，采用系统聚类分析对样本进行分组，对比分析各组的骨性退变、椎间盘退变和颈椎功能障碍指数量表（NDI）评分。结果 共纳入129名病例，均为男性。系统聚类将样本分为3个群组：高Pavlov比值组，21例，Pavlov比值为1.12~1.23（1.18±0.04）；中Pavlov比值组，84例，Pavlov比值为0.83~1.11（0.96±0.06）；低Pavlov比值组，24例，Pavlov比值为0.69~0.82（0.77±0.04）。3组间椎体矢状径、椎管矢状径、侧块宽度、椎板宽度、Pavlov比值、侧块宽度/椎板宽度比值、骨性退变、Pfirrmann分级和Kang分级差异均有统计学意义（P均< 0.05）。高Pavlov比值组主要表现为低椎体矢状径、高椎管矢状径和高椎板宽度，骨性退变最严重；中Pavlov比值组表现为高侧块宽度、高侧块宽度/椎板宽度比值，骨性退变最轻；低Pavlov比值组表现为高椎体矢状径、低椎管矢状径和低椎板宽度，Pfirrmann分级和Kang分级最高。3组间年龄、颈椎曲度和NDI评分差异均无统计学意义（P均>0.05）。总体Pavlov比值与NDI评分无明显相关性（r=-0.035，P=0.691），高Pavlov比值组Pavlov比值与NDI评分呈正相关（r=0.541，P=0.011），中Pavlov比值组Pavlov比值与NDI评分无明显相关（r=-0.057，P=0.604），低Pavlov比值组Pavlov比值与NDI评分呈负相关（r=-0.642，P=0.001）。结论 与颈椎Pavlov比值居中的患者相比，比值偏高或偏低的患者存在椎体和椎弓的发育不均衡，骨性退变及椎间盘退变更加明显；患者临床症状的严重程度随Pavlov比值的离中趋势增加而增加。Pavlov比值可作为颈痛及颈椎退变高危解剖因素，或可成为衡量部队特定岗位胜任力的参考选拔指标。 |
| 关键词: Pavlov比值 慢性非特异性颈痛 聚类分析 职业胜任 |
| DOI：10.16781/j.0258-879x.2021.12.1374 |
| 投稿时间：2021-09-24 |
| 基金项目: |
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| Pavlov ratio characteristics of non-specific chronic neck pain in young and middle-aged military population based on cluster analysis |
| LUO Xi1△,JI Cheng-long1△,SUN Kai-qiang1,SUN Jing-chuan1,YUAN Yuan2,SHI Jian-gang1* |
(1. Department of Orthopaedics, Changzheng Hospital, Naval Medical University (Second Military Medical University), Shanghai 200003, China;
2. School of Material Science and Engineering, East China University of Science and Technology, Shanghai 200237, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To investigate the effect of cervical Pavlov ratio on cervical degeneration and cervical-related clinical manifestations in young and middle-aged military population.Methods The demographic, imaging and clinical data of 18-40 years old military patients mainly complaining "neck pain" longer than 3 months were collected from Jan. 2021 to Aug. 2021. All samples were grouped by systematic cluster analysis according to X-ray measurement data. The bone degeneration, intervertebral disc degeneration and neck disability index (NDI) scores of the groups were compared and analyzed.Results A total of 129 cases (all males) were included. The samples were divided into 3 groups:high Pavlov ratio group (1.12-1.23[1.18±0.04], 21 cases), medium Pavlov ratio group (0.83-1.11[0.96±0.06], 84 cases) and low Pavlov ratio group (0.69-0.82[0.77±0.04], 24 cases). There were significant differences in vertebra diameter (VD), canal diameter (CD), lateral mass width (LM), spinolaminar line-to-lateral mass distance (SL), Pavlov ratio, LM/SL ratio, bone degeneration, Pfirrmann grade and Kang grade among the 3 groups (all P < 0.05). High Pavlov ratio group mainly manifested low VD, high CD and SL, with most serious bone degeneration; medium Pavlov ratio group showed high LM and LM/SL ratio, with the lightest bone degeneration; and low Pavlov ratio group presented high VD, low CD and SL, with the highest Pfirrmann grade and Kang grade. No significant difference was observed in age, lordosis or NDI score among the 3 groups (all P>0.05). There was no significant correlation between overall Pavlov ratio and NDI score (r=-0.035, P=0.691). A positive correlation between Pavlov ratio and NDI score in the high Pavlov ratio group (r=0.541, P=0.011) and a negative correlation in the low Pavlov ratio group (r=-0.642, P=0.001) were demonstrated, without significant correlation in the medium Pavlov ratio group (r=-0.057, P=0.604).Conclusion Compared with patients of medium Pavlov ratio, the patients of high or low ratio present unbalanced development of vertebra and vertebral arch and more obvious degeneration of bone and intervertebral disc, and the severity of clinical symptoms increases with the escalation of the deviation trend of the Pavlov ratio. Pavlov ratio can be used as a high-risk anatomic factor for the neck pain and cervical spine degeneration, or as a reference selection index to measure the competency of specific posts in the army. |
| Key words: Pavlov ratio non-specific chronic neck pain cluster analysis professional competence |
