青少年特发性脊柱侧凸的冠状位畸形对矢状位参数的影响

The influence of coronal deformity on sagittal parameters of adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  冠状位畸形  矢状位参数  影像学研究

英文关键词:Adolescent idiopathic scoliosis  Coronal deformity  Sagittal alignments  Radiographic study

中文摘要:

  【摘要】 目的：探讨青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者的冠状位畸形和矢状位平衡间的关系。方法：回顾2006年6月～2012年10月收治的AIS患者的影像学资料，测量参数包括：结构性侧凸的Cobb角、胸椎后凸（thoracic kyphosis，TK）、腰椎前凸（lumbar lordosis，LL）、骶骨倾斜角（sacral slope，SS）、骨盆入射角（pelvic incidence，PI）、骨盆倾斜角（pelvic tilt，PT）、脊柱骶骨角（spine-sacral angle，SSA）以及C7转移比值（C7 translation ratio，C7TR）。记录患者侧凸的Lenke类型和Roussouly类型，比较不同Lenke曲线类型（curve types，CT）、Lenke腰弯修正（lumbar modifiers，LM）、侧弯数量（curve amounts，CA）组间的矢状位参数；对冠、矢状面的参数进行相关性研究。结果：共获得165例AIS患者的影像学资料，男45例，女120例，平均年龄14.8±2.0岁。Lenke 1型70例，2型33例，3型15例，4型21例，5型17例，6型9例。PI平均值为43.0°±9.3°。不同CT组的TK、PT间的差异有统计学意义，其他参数间的差异无统计学意义。不同CA组的TK、LL、PT间的差异显著（P<0.05），而不同LM仅有TK不同（P<0.05）。不同侧凸类型患者的Roussouly类型的分布情况相似（P=0.753）。胸弯的Cobb角与LL、SS、SSA呈负相关（P<0.05），腰弯的Cobb角与矢状位参数间无显著相关性。结论：AIS患者的冠状位畸形可影响部分矢状位参数的值，但不影响整体矢状位类型的分布情况。不同AIS类型的TK、LL和PT不同，而其他参数并无明显差异。脊柱侧凸矫形手术需要考虑冠、矢状位参数间的上述关系。

英文摘要:

  【Abstract】 Objectives: To investigate the relationship between coronal deformity and sagittal alignments of patients with adolescent idiopathic scoliosis(AIS). Methods: The X-rays of AIS patients were retrospectively reviewed from June 2006 to October 2012. The parameters were measured included: Cobb angles of structural curves, thoracic kyphosis(TK), lumbar lordosis(LL), sacral slope(SS), pelvic incidence(PI), pelvic tilt(PT), spino-sacral angle(SSA) and C7 translation ratio(C7TR). Lenke and Roussouly classifications of all patients were recorded to compare the sagittal parameters of the subjects with different Lenke curve types(CT), Lenke lumbar modifiers(LM) and curve amounts(CA). Correlation analysis was performed between coronal and sagittal parameters. Results: A total of 165 AIS patients with 45 males and 120 females was recruited. The mean age was 14.8±2.0 years old. The amount of subjects from Lenke 1 to Lenke 6 was 70, 33, 15, 21, 17 and 9 respectively. The mean PI was 43.0°±9.3°. No significant differences of parameters in each group were found except for TK and PT among different CT groups. TK, LL and PT among different CA groups was significantly different(P<0.05), while only TK showed such difference in each LM group. The subjects with different Lenke types had similar distribution of Roussouly classification(P=0.753). Besides, the Cobb angle of main thoracic curve was negatively correlated with LL, SS and SSA(P<0.05). No significant correlation was found between Cobb angle of lumbar curves and sagittal parameters. Conclusions: Coronal deformities in AIS patients can affect the values of some sagittal spinopelvic parameters, but don′t not change the distribution of sagittal postural patterns. AIS patients in different types have different TK, LL and PT values while a similar PI value. And the above relationships between coronal and sagittal parameters should be considered in the correction surgery of AIS patients.