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[直立姿势对脊柱侧弯中脊柱易感性及脊柱侧弯曲线进展模式的影响]

[Upright posture impact on spine susceptibility in scoliosis and progression patterns of scoliotic curve].

作者信息

Xiao Jun, Wu Zhi-Hong, Qiu Gui-Xing, Yang Xin-Yu, Li Jia-Yi, Weng Xi-Sheng

机构信息

Department of Orthopaedics, PUMC and CAMS, Beijing, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2007 Jan 2;87(1):48-52.

Abstract

OBJECTIVE

To investigate the impact of upright posture on spine susceptibility in scoliosis and scoliotic curve progression patterns.

METHODS

There were 3 groups designed in the experiment: bipedal rats group (n = 26), quadrupedal rats group (n = 26) and sham operation bipedal control (n = 12). Taking the advantage of bipedal rats' upright-posture simulating effect, operations were exerted with posterior central approach between scapulas. Along the spatial of erector spinae muscle and trunk muscles, left side upper (T2-3 or T3-4) and lower (T10-11 or 11 - 12) ribs were tethered with type4 thread to make asymmetrical stress and simulate a primary thoracic curve. At time of 1, 2, 3, 4, 6 and 8 weeks post-operation (PO), each group were taken dorsoventral X-ray photographs for dynamic observation on the difference of scoliosis turnover and to compare the curvature progression difference between bipedal and quadrupedal rats.

RESULTS

Operation resulted in a primary single thoracic curve or thoracolumbar curve convex to the right in both bipedal and quadrupedal rats. At 1 - 4 weeks PO, all asymmetrical tethers became loose because of rib fracture or osteolysis at the tether sites. All scoliosis of quadrupedal rats disappeared and spine resume straight in 1 - 4 weeks later. Analogically, scoliosis disappeared in bipedal rats for those tethers loose in 1 w PO. But prolonged tethering, scoliosis progression rates increased conspicuously. 3 - 4 weeks' tether time led to irreversible scoliosis. Meanwhile, the curvature progression patterns of bipedal rats presented to be various, including the stable single thoracic curve, progressive thoracolumbar single curve and progressive double curve. These curvatures were much alike that of human idiopathic scoliosis. No scoliosis appeared in sham operation bipedal control.

CONCLUSIONS

The upright posture increased spinal susceptibility in scoliosis; Upright posture changes the progression pattern of scoliosis, leading to variegated scoliotic morphouses during primary thoracic curve progression, while inducing curve compensation phenomenon in scoliosis.

摘要

目的

探讨直立姿势对脊柱侧凸患者脊柱易感性及脊柱侧凸曲线进展模式的影响。

方法

实验设计了3组:双足大鼠组(n = 26)、四足大鼠组(n = 26)和假手术双足对照组(n = 12)。利用双足大鼠的直立姿势模拟效应,采用肩胛间后正中入路进行手术。沿竖脊肌和躯干肌间隙,用4号线将左侧上位(T2 - 3或T3 - 4)和下位(T10 - 11或11 - 12)肋骨系住,制造不对称应力,模拟原发性胸弯。术后1、2、3、4、6和8周,对每组大鼠进行正侧位X线摄片,动态观察脊柱侧凸的变化情况,比较双足和四足大鼠的曲率进展差异。

结果

手术导致双足和四足大鼠均出现原发性单一胸弯或胸腰弯,凸向右侧。术后1 - 4周,由于肋骨骨折或系线部位骨质溶解,所有不对称系线均松弛。所有四足大鼠的脊柱侧凸在1 - 4周后消失,脊柱恢复挺直。类似地,术后1周系线松弛的双足大鼠脊柱侧凸消失。但系线时间延长,脊柱侧凸进展率显著增加。系线3 - 4周导致不可逆的脊柱侧凸。同时,双足大鼠的曲率进展模式呈现多样化,包括稳定的单一胸弯、进行性胸腰单一曲线和进行性双曲。这些曲率与人类特发性脊柱侧凸非常相似。假手术双足对照组未出现脊柱侧凸。

结论

直立姿势增加了脊柱侧凸患者的脊柱易感性;直立姿势改变了脊柱侧凸的进展模式,导致原发性胸弯进展过程中脊柱侧凸形态多样,同时诱发脊柱侧凸的曲线代偿现象。

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