Iliopoulos Panagiotis, Korovessis Panagiotis, Koureas Georgios, Zacharatos Spyridon, Stergiou Panagiotis
Institute for Radiology, General Hospital Agios Andreas, Patras, Greece.
Eur Spine J. 2007 Sep;16(9):1343-7. doi: 10.1007/s00586-007-0322-1. Epub 2007 Feb 9.
Breast asymmetry was believed to be related to asymmetry of anterior chest wall blood supply and subsequently to aetiology of idiopathic thoracic scoliosis in female adolescents. Recent investigations on the anterior chest wall blood supply with Colour Doppler Ultrasonography (CDU) in such individuals did not show anatomical and hemodynamic abnormalities. The present study investigated the evolution of anterior chest wall blood supply in these individuals over a 2-year period. Twenty female adolescents with progressive right-convex idiopathic thoracic scoliosis (scoliotics), who were during the study in therapy with horacolumbosacral orthosis (TLSO) and 20 age-matched girls, without spine deformity (controls) were studied with CDU [internal mammary artery (IMA)] twice within the 2-year period. IMA-anatomical parameters [lumen diameter (D) and cross sectional area (AR)] as well as hemodynamic flow parameters [time average mean flow velocity and flow volume per minute (FV)] were measured. In the 2-year-period of observation, TLSO prevented scoliosis progression (P = 0.004), while IMA-AR decreased bilaterally in the individuals of both groups (P < 0.03). In the last evaluation: in scoliotics right IMA FV decreased (P < 0.04), while in controls IMA FV decreased bilaterally (P < 0.03); left IMA FV was significantly higher (P < 0.05) in scoliotics than in controls. The significant, within the 2-year period, decrease of IMA-diameter, cross-sectional area, and flow volume seems to be a physiological ageing process because it was observed in all individuals (scoliotics and controls), and thus these anatomic and hemodynamic changes seem not to have been affected by bracing. The maintenance of left flow volume of IMA in the pre-brace levels in scoliotics was the most significant finding of this investigation. In conclusion, this study provided evidence for abnormalities in the evolution of anterior chest wall blood supply in female adolescents with progressive right-convex female thoracic scoliosis. Further studies are needed to investigate if this asymmetric blood evolution contributes to the development of this pattern of scoliosis in girls.
乳房不对称被认为与前胸壁血液供应的不对称有关，进而与女性青少年特发性胸椎侧弯的病因相关。近期对这类个体进行彩色多普勒超声（CDU）前胸壁血液供应的研究未发现解剖学和血流动力学异常。本研究调查了这些个体在两年期间前胸壁血液供应的演变情况。对20名患有进行性右凸特发性胸椎侧弯的女性青少年（脊柱侧弯患者）进行了研究，她们在研究期间使用胸腰骶矫形器（TLSO）进行治疗，同时选取了20名年龄匹配、无脊柱畸形的女孩作为对照，在两年期间内使用CDU [胸廓内动脉（IMA）] 对她们进行了两次检查。测量了IMA的解剖学参数 [管腔直径（D）和横截面积（AR）] 以及血流动力学参数 [时间平均平均流速和每分钟血流量（FV）]。在两年的观察期内，TLSO阻止了脊柱侧弯的进展（P = 0.004），而两组个体的IMA-AR均双侧下降（P < 0.03）。在最后一次评估中：脊柱侧弯患者右侧IMA的FV下降（P < 0.04），而对照组双侧IMA的FV下降（P < 0.03）；脊柱侧弯患者左侧IMA的FV显著高于对照组（P < 0.05）。在两年期间，IMA直径、横截面积和血流量的显著下降似乎是一个生理老化过程，因为在所有个体（脊柱侧弯患者和对照组）中均观察到，因此这些解剖学和血流动力学变化似乎未受支具影响。脊柱侧弯患者左侧IMA血流量维持在支具佩戴前水平是本研究最显著的发现。总之，本研究为患有进行性右凸女性胸椎侧弯的女性青少年前胸壁血液供应演变异常提供了证据。需要进一步研究来调查这种不对称的血液演变是否促成了女孩这种类型脊柱侧弯的发展。
