先天性脊柱侧凸合并高肩胛征的影像学特征

The radiographic characteristics of congenital scoliosis associated with Sprengel′s deformity

中文关键词:  先天性脊柱侧凸  高肩胛征  影像学特征  肩平衡

英文关键词:Congenital scoliosis  Sprengel′s deformity  Radiographic characteristics  Shoulder imbalance

中文摘要:

  【摘要】 目的：探讨先天性脊柱侧凸（congenital scoliosis，CS）合并高肩胛征患者的影像学特征，并分析高肩胛征与双肩平衡的相关性。方法：回顾性分析2000年1月～2015年10月在我科以脊柱畸形首诊且影像学资料完整的24例CS合并高肩胛征患者，其中男11例，女13例，平均年龄11.8±6.0岁（2～31岁）。通过站立位全脊柱正侧位X线，测量并记录患者侧凸类型、Cobb角、顶椎位置、上下端椎位置、双肩高度差、高肩胛的位置及半椎体位置等。并对双肩高度差和弯型参数进行Spearman相关性分析。结果：24例患者均表现为颈胸椎或胸椎侧凸畸形，平均侧凸Cobb角49.5°±23.3°。侧凸顶椎位于T1～T11，其中16例患者表现为单节段或多节段半椎体畸形，半椎体发生于T4及以上节段10例；合并肋骨畸形15例，其中9例发生于脊柱侧凸的凹侧，3例发生于侧凸凸侧，3例发生于侧凸两侧。高肩胛发生于脊柱侧凸凸侧15例（62.5%）、凹侧7例（29.2%）、双侧2例（8.3%）。高肩胛位于侧凸凸侧的15例患者均为凸侧肩高于凹侧；高肩胛位于侧凸凹侧的7例患者中，5例凹侧肩高于凸侧，2例凸侧肩高于凹侧。双肩高度差平均为15.7±21.0mm。Spearman相关性分析显示，双肩高度差与Cobb角、顶椎位置、上下端椎位置等无明显相关性（P>0.05）。结论：CS合并高肩胛征患者多表现为颈胸段和胸段侧凸畸形，以T4以上节段半椎体多见，高肩胛征及合并的肋骨畸形均多见于脊柱侧凸的凸侧，而双肩高度差与弯型特征无明显相关性。

英文摘要:

  【Abstract】 Objectives: To investigate the radiographic features of congenital scoliosis (CS) associated with Sprengel′s deformity, and to assess the correlation between Sprengel′s deformity and shoulder imbalance in this cohort. Methods: Complete radiographic data of twenty-four CS patients combined with Sprengel′s deformity that were diagnosed with spinal deformity in our center from January 2000 to October 2015 were retrospectively reviewed. There were 11 males and 13 females, and the average age was 11.8±6.0 years(2-31 years). The following parameters were measured on standing whole spinal X-rays: curve pattern, Cobb angle, apical vertebrae, upper and lower end vertebrae, shoulder imbalance, location of Sprengel′s deformity, and levels of hemivertebrae. Spearman correlation analysis was performed to analyze the relationship between shoulder imbalance and the radiographic characteristics. Results: The cervicothoracic or thoracic scoliosis was observed in all patients, and the average Cobb angle was 49.5°±23.3°. The ranges of apical vertebrae were T1-T11. 16 patients were with single or multiple hemivertebrae deformity, which located at T4 or upper levels in 10(62.5%) patients and at T5 or lower levels in 6 patients(37.5%). Rib abnormalities was found in 15 patients, which located on the concave side in 9 patients, convex side in 3 patients, and both sides in 3 patients. The Sprengel′s deformity occurred on convex side of the scoliosis in 15 patients(62.5%), on concave side in 7 patients(29.2%) and on both sides in 2 patients(8.3%), and all showed shoulder of convex side higher than concave side. Of the 7 patients with concave Sprengel′s deformity, the convex shoulder was higher in 2 patients and lower in 5 patients when compared with the concave shoulder. The value of shoulder imbalance was 15.7±21.0mm, which according to the Spearman correlation analysis had no significant correlation with the Cobb angle, apical vertebrae location and upper and lower end vertebrae locations and other radiographic parameters(P>0.05). Conclusions: The cervicothoracic or thoracic scoliosis were the most common curve pattern in CS combined with Sprengel′s deformity. Hemivertebrae were predominantly seen at T4 or upper levels. The Sprengel′s deformity and rib abnormities were more common on convex side of the scoliosis, though no significant correlation was found between shoulder imbalance and the radiographic parameters.