青少年特发性脊柱侧凸不同弯型患者椎体和椎间盘楔形变的差异及临床意义

Contributions of vertebral and disc wedging to the Cobb angle in adolescent idiopathic scoliosis with different curve pattern：radiographic discrepancy and clinical significance

中文关键词:  脊柱侧凸  椎体  椎间盘  楔形变

英文关键词:Scoliosis  Vertebrae  Disc  Wedging

中文摘要:

  【摘要】 目的：比较不同弯型、不同Cobb角的青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者椎体和椎间盘楔形变及其对整体Cobb角构成的差异，探讨其临床意义。方法：2007年1月~2009年6月对收治的110例单弯型AIS患者按弯型分组，其中主胸弯39例（A组），胸腰弯33例（B组），主腰弯38例（C组）。每组根据侧凸Cobb角大小再分为<40°和≥40°两个亚组。分别测量每个主弯范围内所有椎体和椎间盘的楔形变角（楔变角），并分别计算椎体与椎间盘楔变角之和分别占整个主弯Cobb角的百分比（楔变角所占Cobb角比率）。结果：全部患者平均年龄13.6±1.9岁；平均Cobb角34.4°±10.5°；平均Risser征2.4±1.7。三组间平均年龄、Cobb角、Risser征均无显著性差异（P>0.05）。A组椎体楔变角及所占比率明显大于椎间盘（21.9°±5.6°比13.7±5.9°，62.3%比37.7%，P<0.001），B组与C组椎间盘楔变角及所占比率明显大于椎体（24.1°±9.2°比10.4°±3.8°，69.0%比31.0%，P<0.001；25.1°±7.2°比7.7°±2.4°，76.6%比23.4%，P<0.001）。各组内Cobb角≥40°患者的椎体与椎间盘楔变角均显著大于Cobb角<40°患者的楔变角（P<0.001）。随Cobb角增加，A组患者椎体楔变角占整体Cobb角比率仍然大于椎间盘，而B组和C组患者椎间盘楔变角占整体Cobb角比率仍然大于椎体。三组顶椎楔变角均与相应Cobb角大小成显著线性正相关（P<0.001）。结论：AIS各种弯型侧凸均存在不同程度的椎体与椎间盘楔形变。主胸弯Cobb角构成以椎体楔形变为主，胸腰弯和主腰弯则以椎间盘楔形变为主，提示不同弯型间可能存在不同的生物力学发生机制。

英文摘要:

  【Abstract】 Objective：To investigate the difference of contribution to the Cobb angle between vertebral and disc wedging in adolescent idiopathic scoliosis（AIS） with different curve pattern and its clinical significance.Method：Form January 2007 to June 2009，110 AIS patients were divided into three groups according to their curve patterns，which included 39 patients with a major thoracic curve（group A），33 with a thoracolumbar curve（group B） and 38 with major lumbar curve（group C）.According to the Cobb angle（<40° or ≥40°），each group was divided into two subgroups.The wedging angle of every disc and vertebra in whole major curve was measured，and the proportion to the Cobb angle was calculated（wedging percentage） respectively.Result：The average age，Cobb angle and Risser sign of all patients was 13.6±1.9 years，34.4°±10.5° and 2.4±1.7 respectively.No difference with respect to the average age，Cobb angle and Risser sign was observed among three groups（P>0.05）.The wedging angle and wedging percentage of vertebrae were significantly higher than those of discs in group A（21.9°±5.6° vs 13.7°±5.9°，and 62.3% vs 37.7%，P<0.001），however the reverse results in group B and C（24.1°±9.2° vs 10.4°±3.8°，69.0% vs 31.0%，P<0.001；and 25.1°±7.2° vs 7.7°±2.4°，76.6% vs 23.4%，P<0.001）.The wedging angle of vertebra and discs in patients with Cobb angle ≥40° was significantly higher than that in patients with Cobb angle <40°（P<0.001）.Along with the increase of Cobb angle，vertebral wedging still played a major role in contribution to Cobb angle in group A，while disc wedging accounted for the main part in group B and C.Additionally，the wedging angle of apical vertebrae was linearly correlated with the Cobb angle in each group（P<0.001）.Conclusion：Various vertebral and disc wedging exist in adolescent idiopathic scoliosis regardless of the curve patterns.The vertebral wedging contribute more to the Cobb angle in major thoracic curve than discs，while disc wedging contribute more to the Cobb angle in thoracolumbar and lumbar curves，which indicate different biomechanical pathogenesis among varied curve types.