摘要目的:分析胸1倾斜角在3D打印寰枢侧块关节融合器治疗颅颈交界区畸形术后颈椎矢状位平衡中的临床意义，讨论该手术的临床疗效。方法:收集2018年6月至2022年2月在郑州大学第一附属医院骨科行3D打印融合器植入手术的颅颈交界区畸形患者(共25例)的临床资料，记录术前、术后及3、6、12个月随访时的症状评分：视觉模拟疼痛(VAS)、改良日本骨科协会(mJOA)、颈椎功能障碍指数(NDI)；测量矢状位径线：C0~C2角(C0~C2 angle)、C2~C7角(C2~C7 angle)、C2~C7矢状面垂直轴(SVA)、颈倾角(NT)、胸1倾斜角(T1S)、胸廓入射角(TIA)，使用SPSS26.0对所得数据进行统计学分析。结果:患者术前术后VAS(7.64±2.38比3.32±2.62， t＝6.896， P<0.05)、mJOA(7.84±3.63比14.40±3.31， t＝－7.954， P<0.05)、NDI(63.60±18.61比11.72±16.57， t＝11.230， P<0.05)差异有统计学意义；术后各时刻C0~C2角，术前与术后1~3 d C2~C7角、T1S、NT，术前与术后各时刻C2~C7 SVA、TIA差异无统计学意义( t＝－0.168、－1.596、－1.534、1.230、－1.613、－0.122， P>0.05)，术前与术后各时刻C0~C2角[(14.66±10.46)°比(10.55±8.07)°， t＝2.974、2.407、2.642、3.198， P<0.05)，术前与术后3、6、12个月C2~C7角、T1S、NT[(17.35±14.92)°比(24.06±4.81)°，(18.07±6.26)°比(24.13±4.36)°，(54.93±11.90)°比(50.36±10.10)°， t＝－3.253、－3.121、－2.180，－5.047、－4.937、－5.715，3.023、3.110、2.897， P<0.05)差异有统计学意义；ΔC2~C7角与ΔT1S之间明显相关( r＝0.498， P<0.05)；ΔT1S与ΔVAS、ΔNDI评分之间正向相关( r＝0.447、0.467， P<0.05)，与ΔmJOA评分具有负向相关性( r＝－0.501， P<0.05)。 结论:3D打印寰枢侧块关节融合器治疗颅颈交界区畸形术后，患者矢状位平衡得到改善，T1S的改变与临床疗效改变相关，T1S在衡量脊柱矢状位平衡中具有重要意义。

abstractsObjective:To analyze the clinical significance of T1 slope in the sagittal balance of the cervical spine after 3D printed Atlantoaxial block joint fusion in the treatment of craniocervical junction malformation, and to discuss the clinical efficacy of this operation.Methods:The clinical data of patients with craniocervical junction malformation (25 cases) who underwent 3D printing fusion implantation surgery in our department from June 2018 to February 2022 were collected. The symptom scores before and 1-3 days, 3 months, 6 months and 12 months after surgery were recorded and measured: visual analogue scale (VAS), modified Japanese orthopaedic association (mJOA), neckdisabilityindex (NDI). The sagittal radius was measured: C0-C2 angle, C2-C7 angle, C2-C7 SVA, Neck Tilting (NT), T1 slope (T1S), thoracic inlet angle (TIA). SPSS26.0 was used to statistically analyze the obtained data.Results:Patients’ preoperative and postoperative VAS (7.64±2.38 vs. 3.32±2.62, t=6.896, P<0.05), mJOA (7.84±3.63 vs. 14.40±3.31, t=-7.954, P<0.05), and NDI (63.60±18.61 vs. 11.72±16.57, t=11.230, P<0.05) were statistically significant. There were no significant differences in C0-C2 angle at different time points postoperation, C2-C7 angle, T1S, NT before and 1-3 days after operation, and C2-C7 SVA and TIA before and at different time points after operation ( t=-0.168, -1.596, -1.534, 1.230, -1.613, -0.122, P>0.05). There were significant differences in C0-C2 angle before and at different time points after operation [(14.66±10.46)° vs. (10.55±8.07)°, t=2.974, 2.407, 2.642, 3.198, P<0.05], C2-C7 angle, T1S, NT before and at 3, 6 and 12 months after operation [(17.35±14.92)° vs. (24.06±4.81)°, (18.07±6.26)° vs. (24.13±4.36)°, (54.93±11.90)° vs. (50.36±10.10)°, t=-3.253, -3.121, -2.180, -5.047, -4.937, -5.715, 3.023, 3.110, 2.897, P<0.05]. There was a correlation between the ΔC2-C7 angle and ΔT1S ( r=0.498, P<0.05); there was a positive correlation between ΔT1S and ΔVAS, ΔNDI scores ( r=0.447, 0.467, P<0.05) and negative correlation between ΔT1S and ΔmJOA scores ( r=-0.501, P<0.05). Conclusion:After 3D printing atlantoaxial block joint fusion for the adjuvant treatment of craniocervical junction malformation, the sagittal balance of patients was improved, the change of T1 slope was associated with the change of clinical efficacy, and the T1 slope was of great significance in measuring the sagittal balance of the spine.