不同Rigo分型青少年特发性脊柱侧凸患者脊柱三维平面的影像特征

Imaging characteristics of spinal three-dimensional planes in adolescent idiopathic scoliosis patients with different Ｒigo classifications

中文关键词:  青少年特发性脊柱侧凸  Rigo分型  Roussouly分型  影像学

英文关键词:Adolescent idiopathic scoliosis  Rigo classification  Roussouly classification  Imaging

中文摘要:

  【摘要】　目的：探讨不同Rigo分型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者三维平面的影像特征及其之间的关系。方法：回顾性分析215例AIS患者的影像学资料，其中女性186例，男性29例，年龄10~18岁（14.4±2.2岁）。根据患者站立位全脊柱正、侧位X线片表现进行Rigo分型（Rigo A、Rigo B、Rigo C、Rigo E型）、非特定类型和Roussouly分型，并对不同Rigo类型女性患者冠状面、矢状面和水平面特征进行分析，测量主弯Cobb角、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（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）、C7位移比值（C7 translation ratio，C7TR）、顶椎旋转度（apical vertebral rotation，AVR），比较不同性别Rigo类型的差异和不同Rigo类型女性患者的Roussouly分型情况，分析冠状面、矢状面和水平面参数间的相关关系。结果：186例女性患者中Rigo A、B、C、E和非特定类型分别为62例、71例、13例、35例和5例；29例男性患者中分别为12例、7例、2例、4例和4例。不同性别患者Rigo分型的分布存在显著性差异（P=0.048）。不同Rigo分型女性患者Roussouly Ⅰ型与Ⅳ型分布有显著性差异（P=0.005）。女性Rigo A型患者的PI显著性大于Rigo E型（P＜0.05）；Rigo A、B型PT、SS、C7TR显著性大于Rigo E型（P＜0.05）；Rigo B型SSA显著性大于Rigo E型（P＜0.05）。Rigo C型的Cobb角与SS相关（P<0.05）；Rigo A、B、C、E型的Cobb角与AVR呈负相关（P＜0.05）；Rigo　A型的AVR与PI、C7TR相关（P＜0.05），Rigo C型的AVR与SS、PI呈负相关（P＜0.05）。Logistic回归分析显示女性患者矢状面失衡与Cobb角、AVR、SS和Rigo分型无独立相关性，但与PI、PT呈负相关。结论：不同性别AIS患者Rigo分型的分布存在差异；不同Rigo分型女性患者Roussouly Ⅰ型与Ⅳ型分布存在差异，冠状面、矢状面和水平面参数的相互关联特征不一致。

英文摘要:

  【Abstract】 Objectives: To investigate the imaging characteristics of spinal three-dimensional planes and their relationships in adolescent idiopathic scoliosis(AIS) patients with different Rigo classifications. Methods: A retrospective analysis was conducted on the imaging data from 215 AIS patients(186 females and 29 males) aged 10-18 years(14.4±2.2 years). Patients were classified according to the Rigo classification(Rigo A, Rigo B, Rigo C, Rigo E types), and non-specific type and Roussouly classification based on standing full-spine anteroposterior and lateral X-rays. The coronal, sagittal, and axial plane features of female patients with different Rigo types were analyzed. The main curve Cobb angle, thoracic kyphosis(TK), lumbar lordosis(LL), sacral slope(SS), pelvic incidence(PI), pelvic tilt(PT), spine-sacral angle(SSA), C7 translation ratio(C7TR), and apical vertebral rotation(AVR)were measured. The Rigo classifications in genders, as well as the distribution of Roussouly types among female patients with different Rigo types were compared, and correlations between coronal, sagittal, and axial plane parameters were analyzed. Results: Among the 186 female patients, there were 62 Rigo A, 71 Rigo B, 13 Rigo C, 35 Rigo E, and 5 non-specific types; Among the 29 male patients, there were 12 Rigo A, 7 Rigo B, 2 Rigo C, 4 Rigo E, and 4 non-specific types. Significant differences were found in Rigo classification distribution between sexes(P=0.048). Significant differences in Roussouly type Ⅰ and Ⅳ distributions were observed among female patients with different Rigo types(P=0.005). PI in female Rigo A patients was significantly greater than that in Rigo E(P<0.05); PT, SS, and C7TR in Rigo A and B were significantly greater than in Rigo E(P<0.05); SSA in Rigo B was significantly greater than in Rigo E(P<0.05). Cobb angle correlated with SS in Rigo C(P<0.05). Cobb angle was negatively correlated with AVR in Rigo A, B, C, and E types(P<0.05). AVR was correlated with PI and C7TR in Rigo A(P<0.05), and negatively correlated with SS and PI in Rigo C(P<0.05). Logistic regression showed sagittal plane imbalance wasn′t correlated with Cobb angle, AVR, SS, or Rigo classification, but negatively correlated with PI and PT. Conclusions: Distribution of Rigo classification differs by sex among AIS patients. Significant differences in Roussouly types Ⅰ and Ⅳ exist among female patients with different Rigo types. The interrelationships among coronal, sagittal, and axial plane parameters vary with Rigo classification.