Thoracic inlet angle is not a constant morphological parameter: A cross-sectional study based on asymptomatic Chinese

doi:10.3877/cma.j.issn.1674-0785.2023.10.006

Abstract

Abstract:

Objective

Thoracic inlet angle (TIA) is traditionally considered as a constant morphological parameter and independent of position or movement, but the relationship between TIA and gender, age, and cervical sagittal balance is still controversial. This study aimed to assess the correlation of TIA with sex , age, and cervical sagittal balance in asymptomatic Chinese.

Methods

Four hundred asymptomatic Chinese volunteers were recruited, and they had an average age of 49.9±14.4 years (range, 18~85 years). A standing cervical lateral radiograph in a neutral position in all subjects. Thoracic inlet (TI) parameters, including thoracic inlet angle (TIA), neck tilt (NT), and thoracic (T1) slope (T1S), were measured. Cervical lordosis (CL) and sagittal vertical axis (SVA) were also measured to evaluate the sagittal balance of the cervical spine. Pearson correlation analysis of sex, age, CL, SVA, and TI parameters was performed by using SPSS 27.0 software.

Results

The mean TIA, T1S, NT, SVA, CL, and T1S-CL were (74.2°±10.1°), (26.4°±7.0°), (47.8°±7.8°), (19.0 mm±9.6 mm), (17.0°±11.4°), and (9.4°±8.6°), respectively. TIA, T1S, NT, and CL in male subjects were significantly larger than those in female subjects (P≤0.001). TIA had a significant correlation with sex (r=-0.420), age (r=0.370), T1S (r=0.636), NT (r=0.722), SVA (r=0.225), and CL (r=0.425). TIA showed a increasing trend with the increase in decade years (ANOVA P<0.001), and TIA in male subjects was larger than that of female subjects in each age group(P<0.001). SVA was strongly positively correlated with T1S-CL (r=0.467). TIA was positively correlated with CL (r=0.425). However, TIA was not significantly correlated with T1S-CL (r=-0.05).

Conclusion

Mean TIA is (74.2°±10.1°) in asymptomatic Chinese. TIA is not a constant TI parameter as it increases with age and in males. As a key factor of affecting outcomes after cervical surgery, T1S-CL does not correlate with TIA. Patients with a high TIA can reduce the occurrence of cervical sagittal imbalance by increasing cervical curvature, and TIA is not recommended as an independent factor for predicting sagittal imbalance after cervical spine surgery. These results could serve as baseline data for further studies on the cervicothoracic sagittal balance.

Key words: TIA, Thoracic inlet parameter, Sex, Age, Cervical sagittal balance, Cervical spine

Gengyu Zhang, Chong Tang. Thoracic inlet angle is not a constant morphological parameter: A cross-sectional study based on asymptomatic Chinese[J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(10): 1058-1063.

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Figures/Tables 7

References 22

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颈椎参数	总体（n=400）	男性（n=200）	女性（n=200）	P值
TIA（°）	74.2±10.1（50.3~100.6）	78.4±9.9（50.5~100.6）	70.0±8.3（50.3~92.7）	<0.001
T1S（°）	26.4±7.0（4.9~52.6）	28.1±6.8（9.2~50.3）	24.7±6.7（4.9~52.6）	<0.001
NT（°）	47.8±7.8（26.4~69.3）	50.3±8.0（30.6~69.3）	45.3±6.7（26.4~62.2）	<0.001
SVA（mm）	19.0±9.6（-7.1~58.4）	19.5±10.1（-2.4~58.4）	18.4±9.1（-7.1-43.5）	0.236
CL（°）	17.0±11.4（-23.4-53.5）	19.0±11.4（-23.4-48.7）	15.1±11.2（-19.7~53.5）	0.001
T1S-CL（°）	9.4±8.6（-18.9~35.2）	9.2±8.7（-14.8~34.4）	9.6±8.4（-18.9~35.2）	0.625

颈椎参数	总体（n=400）	男性（n=200）	女性（n=200）	P值
TIA（°）	74.2±10.1（50.3~100.6）	78.4±9.9（50.5~100.6）	70.0±8.3（50.3~92.7）	<0.001
T1S（°）	26.4±7.0（4.9~52.6）	28.1±6.8（9.2~50.3）	24.7±6.7（4.9~52.6）	<0.001
NT（°）	47.8±7.8（26.4~69.3）	50.3±8.0（30.6~69.3）	45.3±6.7（26.4~62.2）	<0.001
SVA（mm）	19.0±9.6（-7.1~58.4）	19.5±10.1（-2.4~58.4）	18.4±9.1（-7.1-43.5）	0.236
CL（°）	17.0±11.4（-23.4-53.5）	19.0±11.4（-23.4-48.7）	15.1±11.2（-19.7~53.5）	0.001
T1S-CL（°）	9.4±8.6（-18.9~35.2）	9.2±8.7（-14.8~34.4）	9.6±8.4（-18.9~35.2）	0.625

参数	性别	年龄	TIA	T1S	NT	SVA	CL	T1S-CL
性别	1	0.013	-0.420^*	-0.249^*	-0.320^*	-0.059	-0.170^*	0.024
年龄		1	0.370^*	0.195^*	0.303^*	0.098	0.269^*	-0.202^*
TIA			1	0.636^*	0.722^*	0.225^*	0.425^*	-0.050
T1S				1	-0.075	0.253^*	0.666^*	-0.075
NT					1	0.065	-0.048	0.003
SVA						1	-0.196^*	0.467^*
CL							1	-0.794^*
T1S-CL								1

参数	性别	年龄	TIA	T1S	NT	SVA	CL	T1S-CL
性别	1	0.013	-0.420^*	-0.249^*	-0.320^*	-0.059	-0.170^*	0.024
年龄		1	0.370^*	0.195^*	0.303^*	0.098	0.269^*	-0.202^*
TIA			1	0.636^*	0.722^*	0.225^*	0.425^*	-0.050
T1S				1	-0.075	0.253^*	0.666^*	-0.075
NT					1	0.065	-0.048	0.003
SVA						1	-0.196^*	0.467^*
CL							1	-0.794^*
T1S-CL								1

参数	<30岁（n=50，M26，F24）	31~40岁（n=68，M32，F36）	41~50岁（n=62，M32，F30）	51~60岁（n=134，M69，F65）	61~70岁（n=58，M28，F30）	>70岁（n=28，M13，F15）	方差分析 P 值
总体	67.8±8.9	70.9±8.8	72.6±9.3	76.2±9.7	78.4±9.6	79.2±10.5	<0.001
男性	70.4±8.6	74.3±9.2	76.7±8.3	81.2±8.9	82.6±9.6	85.6±9.1	<0.001
女性	65.0±8.4^*	67.8±7.3^*	68.3±8.5^*	70.9±7.5^*	74.5±7.9^*	73.6±8.4^*	<0.001

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