右胸弯型女性青少年特发性脊柱侧凸患者乳房发育的不对称性

Evaluation of breast asymmetry in adolescent female patients with right-convex thoracic idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  乳房不对称  前胸壁倾斜角  女性

英文关键词:Adolescent idiopathic scoliosis  Breast asymmetry  Anterior chest wall inclination  Female

中文摘要:

  【摘要】 目的：评估右胸弯型女性青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者乳房的不对称性及其与脊柱畸形指标和前胸壁畸形指标的相关性。方法：2010年6月~2011年6月在我院接受手术治疗的73例右胸弯型女性AIS患者，Lenke Ⅰ型63例，Lenke Ⅱ型10例，手术年龄11~21岁，平均14.82±2.69岁；主胸弯Cobb角40°~90°，平均52.08°±11.68°。术前均行全脊柱CT扫描，采用Image J软件进行三维重建，测量凹、凸侧乳房体积（breast volume，BV），同时在二维CT图片上测量乳房外倾角、乳房覆盖角、乳房下胸壁角、乳头至胸骨中线距离、乳房轴高及乳房纵高。乳房不对称性指数（breast asymmetry index，BAI）定义为（凹侧-凸侧）BV/[（凹侧+凸侧）BV]/2，BAI>5%或<-5%时定义为凹凸侧乳房不对称。脊柱畸形指标包括RAsag角和RAml角。采用配对t检验分析凹、凸侧乳房各指标的不对称程度，用Pearson相关分析研究BAI与脊柱畸形指标之间的相关性以及乳房指标和前胸壁指标之间的相关性。结果：凹侧BV、乳房外倾角、乳房轴高及乳房纵高分别为283.19±153.89ml、26.32°±9.68°、29.28±7.26mm、17.42±6.35cm，均显著大于凸侧的257.42±149.85ml、23.41°±8.24°、27.88±7.70mm、16.73±6.41cm（P<0.05）；凹侧乳房覆盖角及乳房下胸壁角分别为95.39°±8.42°、57.61°±8.49°，均显著小于凸侧的106.34°±9.57°、61.43°±6.73°（P<0.05）。凹、凸侧乳头至胸骨中线距离无显著性差异（P>0.05）。BAI平均值为11.4%，其凹侧BV大于凸侧的比率为80.8%，凹凸侧BV不对称的比率为78.1%。BAI达10%以上的分别为52.1%（凹侧>凸侧）和4.1%（凹侧<凸侧）。BAI与Cobb角、RAsag角和RAml角之间均无显著相关性（r=0.049、-0.050、0.037，P>0.05），而乳房下胸壁角与乳房外倾角及乳房覆盖角之间均呈显著相关性（r=-0.857，P<0.001；r=0.411，P<0.001）。结论：大部分右胸弯型女性AIS患者存在凹侧乳房大、凸侧乳房小的不对称性特征。相对于凸侧乳房，凹侧乳房更外倾、更集中（轴高高且覆盖胸壁角度小）。乳房下胸壁的倾斜角度对乳房的方向和覆盖范围有显著的影响，提示BV不对称及胸壁畸形共同参与乳房外观畸形的构成。

英文摘要:

  【Abstract】 Objectives: To evaluate the breast asymmetry in female right-convex thoracic adolescent idiopathic scoliosis(AIS) and define its relationship with deformed components of the chest wall and spine in AIS. Methods: This study included 73 female AIS patients(average surgical age of 14.82±2.69 years, average Cobb angle 52.08°±11.68°) undergoing correction surgery during June 2010 and June 2011. There were 63 Lenke type Ⅰ and 10 Lenke type Ⅱ. The Image J software was utilized to manipulate formatted CT scans into 3-dimensional breast reconstructions so as to calculate the breast volume(BV). Both concave and convex parameters of breast shape were measured including the extraversion angle, the coverage angle, the axial breast height, the coronal breast height and nipple-to-sternum distance. The inclination angles of the concave and convex anterior chest wall were also measured. Breast asymmetry index(BAI) was defined as follows: (concave-convex)BV/[(concave+convex)BV]/2. Breast asymmetries were classified as being obviously different in size when BAI being either >5% or <-5%. The measurement of spinal deformity parameters involved the RAsag angle and the RAml angle. Paired t-test was performed to analyze the asymmetry of breast shape, and Pearson correlation analysis was utilized to define the correlation of the spinal deformity and the inclination of anterior chest wall with BAI. Results: The concave BV, the extraversion angle, the axial breast height and the coronal breast height(283.19±153.89ml, 26.32°±9.68°, 29.28±7.26mm, 17.42±6.35cm) was significantly higher than those of the convex side(257.42±149.85ml, 23.41°±8.24°, 27.88±7.70mm, 16.73±6.41cm, P<0.05) respectively, while the concave coverage angle and the inclination angles of the anterior chest wall(95.39°±8.42°, 57.61°±8.49°) was significantly lower than those of the convex side(106.34°±9.57°, 61.43°±6.73°, P<0.05) respectively. No difference was detected for the concave and convex nipple-to-sternum distance. The average BAI was 11.4%, and the concave breasts were objectively larger in 80.8% of the recruited patients. According to the classification of breast asymmetry, the obviously different bilateral breast size accounted for 78.1%, with the ratio of asymmetry beyond 10% being 52.1%(concave>convex) and 4.1%(concave0.05). The inclination angle of the anterior chest wall demonstrated significant correlation with the extraversion angle(r=-0.857, P<0.001) and the concave coverage angle（r=0.411, P<0.001), respectively. Conclusions: Majority of the right thoracic AIS patients was afflicted to some degrees by breast asymmetries, with the concave breast being larger, more extraversive and more concentrated than the convex breast. The variation of the anterior chest wall inclination introduced by scoliosis has a major influence on breast shape, suggesting a synergistic role of chest wall deformity and volume difference in the formation of breast asymmetry.