后路脊柱矫形术对右胸弯型女性青少年特发性脊柱侧凸患者乳房对称性的美学影响

Influence of correction surgery on breast asymmetry in female adolescent idiopathic scoliosis with right-convex thoracic curve

中文关键词:  青少年特发性脊柱侧凸  乳房不对称性  矫形手术  美学

英文关键词:adolescent idiopathic scoliosis, breast asymmetry, correction surgery  aesthetics

中文摘要:

  【摘要】 目的：探讨后路脊柱矫形术对右胸弯型女性青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者乳房对称性的美学影响。方法：回顾性分析2012年10月～2013年12月于我院行脊柱侧凸后路矫形术且有完整影像学及正面外观照片资料的60例乳房Tanner分级不小于3级的右胸弯型女性AIS患者，于其术前、术后外观照上测量凹凸侧的乳房美学指标，包括乳头间距（nipple-nipple length，NNL）、乳头至锁骨中点距离（clavicle-nipple length，CNL）、乳头至胸骨轴线距离（middle sternum-nipple length，MSNL）、乳头至胸骨上窝距离（sternal notch-nipple length，SNNL）、乳房内径（medial mammary radius，MR）、乳房下径（inferior mammary radius，IR）及乳房外倾角（α角）。乳房不对称程度定义为凹侧-凸侧的差值，其绝对值越小，不对称程度越低。采用配对t检验分别比较术前、术后凹凸侧乳房各个指标的不对称程度及手术对不对称程度的影响。结果：术前CNL、MSNL、SNNL、MR、IR、α角凹凸侧不对称程度分别为-1.7±7.1mm、3.0±7.2mm、2.4±8.4mm、7.5±6.6mm、1.3±3.9mm、-1.2°±5.1°，其中MSNL、SNNL、MR及IR在凹凸侧存在显著不对称差异（P<0.05）。术后CNL、MSNL、SNNL、MR、IR、α角凹凸侧不对称程度分别为3.3±6.0mm、2.5±6.8mm、3.4±8.4mm、7.2±6.9mm、0.2±4.4mm、-2.6°±5.3°，其中CNL、MSNL、SNNL、MR和α角在凹凸侧存在显著不对称差异（P<0.05）。配对t检验示CNL和α角的术后不对称程度显著加重（P<0.05），SNNL术后不对称程度亦加重，但无统计学差异（P>0.05）。结论：脊柱矫形手术打破了右胸弯型女性AIS患者凹凸侧乳房美学指标在适应脊柱畸形发展过程中形成的相对平衡状态。术前相对对称的乳头至锁骨中点距离及乳房外倾角的凹凸侧不对称程度在术后明显变大，从而进一步加重了乳房的整体不对称程度。

英文摘要:

  【Abstract】 Objectives: To evaluate the influence of correction surgery on breast asymmetry in female adolescent idiopathic scoliosis(AIS) with right-convex thoracic curve. Methods: This study recruited 60 female AIS patients undergoing correction surgery from October 2012 to December 2013, with their Tanner stages being 3, 4 or 5 for breast development. The following concave and convex aesthetic parameters were measured on the photos both pre- and post-operatively: the nipple-nipple length(NNL), clavicle-nipple length(CNL), middle sternum-nipple length(MSNL), sternal notch-nipple length(SNNL), medial mammary radius(MR), inferior mammary radius(IR) and extraversion angle(α). Paired t-test was performed to analyze the asymmetry of aesthetic breast parameters between the concave and convex side both pre- and post-operatively, as well as the influence of correction surgery on severity of breast asymmetry. Results: The asymmetry of CNL, MSNL, SNNL, MR, IR and α was -1.7±7.1mm, 3.0±7.2mm, 2.4±8.4mm, 7.5±6.6mm, 1.3±3.9mm and -1.2°±5.1° pre-operatively, and 3.3±6.0mm, 2.5±6.8mm, 3.4±8.4mm, 7.2±6.9mm, 0.2±4.4mm and -2.6°±5.3° post-operatively. Significant difference was noted for MSNL, SNNL, MR and IR pre-operatively, and CNL, MSNL, SNNL, MR and α post-operatively. The paired t test indicated the significant aggravation of asymmetry in terms of CNL and α(P<0.05). The asymmetry of SNNL also increased though no statistically significant difference was confirmed(P>0.05). Conclusions: The correction surgery breaks the relatively regional balance of breast morphology, which causes the pre-operatively symmetrical CNL and α evolving to be asymmetrical postoperatively, and thus indicates an adverse influence of correction surgery on breast morphology.