Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
Spine (Phila Pa 1976). 2010 Feb 15;35(4):416-22. doi: 10.1097/BRS.0b013e3181b3564a.
A prospective study comparing supine bending, push-prone, and traction under general anesthesia (UGA) radiographs in adolescent idiopathic scoliosis.
To compare the effectiveness of 3 different flexibility methods on structural and nonstructural main thoracic (MT) and thoracolumbar/lumbar (TL/L) curves.
Supine side bending radiographs are the major method for determining curve reducibility. Push-prone radiographs show structural and compensatory curves on the same radiograph, but have not shown comparative reducibility in recent studies. Traction UGA is a relatively new modality which may offer similar or improved flexibility, while also showing structural and compensatory curves on the same radiograph.
Fifty-eight patients with adolescent idiopathic scoliosis were prospectively studied with standing PA and lateral, supine bending and push-prone radiographs before surgery; traction UGA radiographs intraoperatively; and standing PA and lateral radiographs after surgery.
Traction UGA demonstrated equal flexibility to supine bending in structural MT and TL/L curves, with a trend towards more flexibility in severe MT curves > or = 60 degrees, while push-prone demonstrated significantly less flexibility. Each of the methods showed significantly less flexibility than postoperative correction in MT curves, while traction UGA and supine bending were not significantly different than postoperative correction in TL/L curves. Analysis of nonstructural TL/L curves showed that traction UGA and push-prone were not significantly different than postoperative correction, while supine bending overestimated postoperative correction.
Traction UGA offers flexibility equivalent to supine bending for structural MT and TL/L curves, and flexibility comparable with push-prone for nonstructural TL/L curves. Traction UGA also shows both structural and compensatory curves on the same radiograph, and ultimately may provide a better estimate of spinal balance.
一项前瞻性研究比较了青少年特发性脊柱侧凸患者在全身麻醉下仰卧弯曲、俯推和牵引时的侧位片。
比较 3 种不同柔韧性测量方法对结构性和非结构性主胸（MT）和胸腰/腰椎（TL/L）曲线的影响。
仰卧位侧位片是确定曲线可屈伸性的主要方法。俯推位片可在同一张片上显示结构性和代偿性曲线，但在最近的研究中并未显示出可比的可屈伸性。牵引全身麻醉是一种相对较新的方法，它可能提供类似或更好的柔韧性，同时在同一张片上显示结构性和代偿性曲线。
58 例青少年特发性脊柱侧凸患者前瞻性研究，术前拍摄站立前后位和侧位、仰卧位侧位和俯推位片；术中行牵引全身麻醉位片；术后拍摄站立前后位和侧位片。
牵引全身麻醉在结构性 MT 和 TL/L 曲线中的柔韧性与仰卧位侧位片相当，在>60°的严重 MT 曲线中，柔韧性有增加趋势，而俯推位片的柔韧性明显较小。每种方法在 MT 曲线中的柔韧性均显著小于术后矫正值，而牵引全身麻醉和仰卧位侧位片在 TL/L 曲线中的柔韧性与术后矫正值无显著差异。非结构性 TL/L 曲线分析表明，牵引全身麻醉和俯推位片与术后矫正值无显著差异，而仰卧位侧位片则高估了术后矫正值。
牵引全身麻醉在结构性 MT 和 TL/L 曲线中的柔韧性与仰卧位侧位片相当，在非结构性 TL/L 曲线中的柔韧性与俯推位片相当。牵引全身麻醉还可在同一张片上显示结构性和代偿性曲线，最终可能提供更好的脊柱平衡估计。
