Kirk Kevin L, Kuklo Timothy R, Polly David W
Department of Orthopaedics and Rehabilitation, Orthopaedic Surgery Service, Walter Reed Army Medical Center, Washington, DC, USA.
Am J Orthop (Belle Mead NJ). 2003 Jun;32(6):284-8.
This is a consecutive study of patients with adolescent idiopathic scoliosis requiring surgical intervention. The purpose was to determine the best radiographic method of evaluating the flexibility of the proximal thoracic (PT) curve in patients with a double thoracic curve pattern. The PT curve averaged 40 degrees (range, 27 degrees-67 degrees) on posteroanterior (PA) radiographs, 30 degrees (range, 12 degrees60 degrees) on supine side-bending radiographs, and 24 degrees (range, 8 degrees -55 degrees) on traction radiographs. The flexibility index (FI) for the PT curve was 0.72 (range, 0.40-0.96) on side-bending and 0.58 (range, 0.29-0.82) on traction. The main thoracic (MT) curve averaged 62 degrees (range, 45 degrees-102 degrees) on PA, 40 degrees (range, 19 degrees-88 degrees) on supine side-bending, and 35 degrees (range, 17 degrees-76 degrees) on traction radiographs. The FI for the MT curve was 0.62 (range, 0.30-0.89) on side bending and 0.56 (range, 0.32-0.81) on traction. There was a statistically significant difference between the flexibility of the PT curve on supine traction as compared with the side-bending films (P<0.0005). Comparison of the MT curve flexibility with the PT curve demonstrated the PT curve to be less flexible in 11 of 15 cases (P = 0.16). The authors conclude that for double thoracic curve patterns, the PT curve is usually the smaller, yet often the stiffer curve. Furthermore, the supine traction radiograph demonstrates greater flexibility of the PT curve than does the supine side-bending radiograph. Clinically, this may assist scoliosis surgeons in assessing the PT curve and achieving a stable, balanced spine.
这是一项针对需要手术干预的青少年特发性脊柱侧凸患者的连续性研究。目的是确定评估双胸弯型患者近端胸椎（PT）曲线柔韧性的最佳影像学方法。PT曲线在后前位（PA）X线片上平均为40度（范围27度至67度），仰卧位侧弯X线片上为30度（范围12度至60度），牵引X线片上为24度（范围8度至55度）。PT曲线的柔韧性指数（FI）在侧弯时为0.72（范围0.40至0.96），在牵引时为0.58（范围0.29至0.82）。主胸弯（MT）曲线在PA片上平均为62度（范围45度至102度），仰卧位侧弯时为40度（范围19度至88度），牵引X线片上为35度（范围17度至76度）。MT曲线的FI在侧弯时为0.62（范围0.30至0.89），在牵引时为0.56（范围0.32至0.81）。与侧弯片相比，仰卧位牵引时PT曲线的柔韧性存在统计学显著差异（P<0.0005）。MT曲线与PT曲线柔韧性的比较显示，15例中有11例PT曲线柔韧性较差（P = 0.16）。作者得出结论，对于双胸弯型，PT曲线通常较小，但往往较僵硬。此外，仰卧位牵引X线片显示PT曲线比仰卧位侧弯X线片具有更大的柔韧性。临床上，这可能有助于脊柱侧凸外科医生评估PT曲线并实现稳定、平衡的脊柱。
