重力对女性青少年特发性脊柱侧凸患者椎体旋转的影响

The influence of gravity to the vertebral rotation in AIS patients: a study based on EOS imaging system

中文关键词:  青少年特发性脊柱侧凸  椎体旋转  EOS影像系统  站立位  平卧位

英文关键词:Adolescent idiopathic scoliosis  Vertebral rotation  EOS imaging system  Standing position  Supine position

中文摘要:

  【摘要】 目的：通过比较站立位EOS全脊柱三维重建和平卧位CT平扫得到的不同的椎体旋转，探讨重力对女性青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者椎体旋转的影响。方法：本研究纳入了2017年5月前在我院行后路脊柱侧凸矫形术的Lenke 1A型及Lenke 5C型女性AIS患者25例。所有患者在术前均分别进行EOS全脊柱成像、CT平扫及三维重建。通过sterEOS软件测量得到患者站立位顶椎旋转（apical vertebral rotation，AVR）、上下端椎的旋转以及每个椎体之间的相对旋转。通过CT平扫的图像得到平卧位的AVR以及每个椎体之间的相对旋转。通过配对样本t检验比较两种体位下各轴状面的旋转参数的差异。结果：共有15例胸椎AIS（T-AIS）患者和10例腰椎AIS（L-AIS）患者纳入本次研究，T-AIS患者的站立位AVR为22.3°±6.4°，显著大于平卧位状态下的18.7°±6.1°（P＜0.05），两者之间差值平均为3.6°。L-AIS患者的AVR在站立位和平卧位时的差异也存在统计学意义（28.4°±7.5° vs. 22.6°±7.2°）（P＜0.05），两组之间的差值平均为5.8°。T-AIS和L-AIS患者的端椎旋转同样在站立位上显著大于平卧位，且T-AIS的下端椎选择及L-AIS患者的上端椎旋转变化较大。相关性分析显示在T-AIS和L-AIS患者中，所有椎体旋转参数在站立位和平卧位均存在显著相关性。结论：重力对特发性脊柱侧凸患者的椎体旋转有一定影响，从站立位到平卧位时，所有椎体的旋转均减小而邻椎间的相对椎体旋转并无显著变化。

英文摘要:

  【Abstract】 Objectives: To investigate the changes of the vertebral rotation from standing position to supine position of the thoracic adolescent idiopathic scoliosis(T-AIS) patients, by comparing the different vertebral rotation obtained by standing EOS 3D full spine reconstructions and supine CT scans. Methods: Twenty-five female AIS patients with Lenke type 1A and Lenke type 5C curve who underwent posterior spinal fusion surgery in our hospital in May 2017 were included. All patients underwent EOS 3D full spine reconstructions and CT scans. The sterEOS software was used to obtain the apical vertebral rotation, the rotation of the upper and lower end vertebrae and the relative rotation of every vertebral body of patients in standing position. The apical vertebral rotation(AVR) and the relative rotation of every vertebral body were also measured on the CT images scanned in supine position. The difference of the rotation parameters of each axial plane in different positions was compared by the paired sample t test. Results: A total of 15 T-AIS patients and 10 lumbar adolescent idiopathic scoliosis(L-AIS) patients were included in this study. The AVR of the T-AIS was 22.3°±6.4° in standing position, significantly greater than 18.7°±6.1° in supine position, and the average difference was 3.6°. Similarly, the difference of AVR between standing position and supine position in L-AIS patients was statistically significant(28.4°±7.5° vs. 22.6°±7.2°), with an average difference of 5.8°. The end vertebral rotation of T-AIS and L-AIS patients in standing position was also significantly larger than that in supine position. In addition, the changes of the lower end vertebral rotation in T-AIS patients and the upper end vertebral rotation in L-AIS patients were larger. Correlation analysis showed that all vertebral rotation parameters in T-AIS and L-AIS patients had significant correlations in both standing position and supine position. Conclusion: The vertebral rotation in AIS patients is influenced by gravity, all the vertebral rotations were reduced but the relative vertebral rotation of the adjacent vertebrae did not change significantly, when idiopathic scoliosis patients changed from standing position to supine position.