Orthopaedic Departments, University Children's Hospital, Roemergasse 8, 4005, Basel, Switzerland.
Eur Spine J. 2010 May;19(5):732-8. doi: 10.1007/s00586-010-1320-2. Epub 2010 Feb 26.
Knowledge about segmental flexibility in adolescent idiopathic scoliosis is crucial for a better biomechanical understanding, particularly for the development of fusionless, growth-guiding techniques. Currently, there is lack of data in this field. The objective of this study was, therefore, to compute segmental flexibility indices (standing angle minus corrected angle/standing angle). We compared segmental disc angles in 76 preoperative sets of standing and fulcrum-bending radiographs of thoracic curves (paired, two-tailed t tests, p < 0.05). The mean standing Cobb angle was 59.7 degrees (range 41.3 degrees -95 degrees ) and the flexibility index of the curve was 48.6% (range 16.6-78.8%). The disc angles showed symmetric periapical distribution with significant decrease (all p values <0.0001) for every cephalad (+) and caudad (-) level change. The periapical levels +1 and -1 wedged at 8.3 degrees and 8.7 degrees (range 3.5 degrees -14.8 degrees ), respectively. All angles were significantly smaller on the-bending views (p values <0.0001). We noted mean periapical flexibility indices of 46% (+1), 49% (-1), 57% (+2) and 81% (-2), which were significantly less (p < 0.001) than for the group of remote levels 105% (+3), 149% (-3), 231% (+4) and 300% (-4). The discal and bony wedging was 60 and 40%, respectively, and mean values 35 degrees and 24 degrees (p < 0.0001). Their relationship with the Cobb angle showed a moderate correlation (r = 0.56 and 0.45). Functional, radiographic analysis of idiopathic thoracic scoliosis revealed significant, homogenous segmental tethering confined to four periapical levels. Future research will aim at in vivo segmental measurements in three planes under defined load to provide in-depth data for novel therapeutic strategies.
青少年特发性脊柱侧凸的节段柔韧性知识对于更好地理解生物力学至关重要,特别是对于开发无融合、生长引导技术而言。目前,该领域缺乏数据。因此,本研究的目的是计算节段柔韧性指数(站立角度减去校正角度/站立角度)。我们比较了 76 例术前站立位和支点弯曲位胸弯的影像学资料(配对双侧 t 检验,p<0.05)。平均站立 Cobb 角为 59.7 度(范围 41.3 度-95 度),曲线的柔韧性指数为 48.6%(范围 16.6-78.8%)。椎间盘角度呈对称的根尖分布,每向上(+)和向下(-)一个椎体水平变化均显著减小(所有 p 值均<0.0001)。根尖水平+1 和-1 分别楔变 8.3 度和 8.7 度(范围 3.5 度-14.8 度)。所有角度在弯曲位均显著减小(p 值均<0.0001)。我们记录了平均根尖柔韧性指数为 46%(+1)、49%(-1)、57%(+2)和 81%(-2),明显小于(p<0.001)远节段 105%(+3)、149%(-3)、231%(+4)和 300%(-4)的柔韧性指数。椎间盘和骨的楔变分别为 60%和 40%,平均为 35 度和 24 度(p<0.0001)。它们与 Cobb 角的关系呈中度相关(r=0.56 和 0.45)。特发性胸弯的功能、影像学分析显示,显著的、同质的节段性固定局限于四个根尖水平。未来的研究将旨在在三个平面下进行有定义负荷的节段体内测量,为新的治疗策略提供深入的数据。
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