Labelle Hubert, Aubin Carl-Eric, Jackson Roger, Lenke Larry, Newton Peter, Parent Stefan
Division of Orthopaedic Surgery, CHU Sainte-Justine, University of Montreal, Montreal.
J Pediatr Orthop. 2011 Jan-Feb;31(1 Suppl):S37-45. doi: 10.1097/BPO.0b013e3181fd8801.
The Scoliosis Research Society (SRS) has appointed a committee to evaluate the clinical relevance and impact of 3D analysis on scoliotic deformities and to develop a 3D classification of adolescent idiopathic scoliosis (AIS). The goal of this article is to summarize and present the work done in recent years within this committee and show how 3D analysis of AIS has the potential to change our current methods to analyse and treat scoliosis.
A database of 600 3D reconstructions of the spine of patients with AIS has been established using calibrated PA and lateral radiographs obtained from either digital radiographs or the EOS system. The 3D reconstructions were done using dedicated software and analyzed with the "da Vinci" view, a schematic top view representation of the 3D reconstructions, which summarizes the position of the End-Apex-End vertebrae planes (planes of maximum curvature).
Preliminary work was done using 3D reconstructions in 409 patients with AIS. Fuzzy clustering techniques were used to show that the cohort could be segmented in 5 easily differentiated curve patterns similar to those of the Lenke and King classifications. Two subsequent articles have shown that 3D reconstructions can be divided in different groups based on the location of the plane of maximum curvature of their curves. One study of 66 cases has shown a consistent loss of kyphosis within the 5 thoracic apical vertebrae. Finally, a study of 172 Lenke 1 curves analyzed by ISO Data cluster analysis has confirmed the presence of 2 statistically different subtypes according to the planes passing through the End-Apex-End vertebrae of the main thoracic curve.
The study presented suggests that a valid and clinically useful 3D classification of AIS is within reach. 3D analysis has the potential to improve our comprehension of AIS curve types and automatic 3D classification may help decrease the known variability of current 2D classifications.
Level III, systematic review of retrospective comparative studies.
脊柱侧弯研究学会（SRS）已任命一个委员会来评估三维分析对脊柱侧弯畸形的临床相关性和影响，并制定青少年特发性脊柱侧弯（AIS）的三维分类。本文的目的是总结并展示该委员会近年来所做的工作，并说明AIS的三维分析如何有可能改变我们目前分析和治疗脊柱侧弯的方法。
利用从数字X线片或EOS系统获得的校准后正位和侧位X线片，建立了一个包含600例AIS患者脊柱三维重建的数据库。三维重建使用专用软件完成，并通过“达芬奇”视图进行分析，这是三维重建的一种示意性顶视图，总结了终椎-顶点-终椎平面（最大曲率平面）的位置。
对409例AIS患者进行了三维重建的初步工作。使用模糊聚类技术表明，该队列可分为5种易于区分的曲线模式，类似于Lenke和King分类。随后的两篇文章表明，三维重建可根据其曲线最大曲率平面的位置分为不同组。一项对66例病例的研究表明，5个胸椎顶椎内的后凸一致丢失。最后，一项对172条Lenke 1曲线进行ISO数据聚类分析的研究证实，根据穿过主胸弯终椎-顶点-终椎的平面，存在2种统计学上不同的亚型。
本研究表明，一种有效且临床有用的AIS三维分类指日可待。三维分析有可能提高我们对AIS曲线类型的理解，自动三维分类可能有助于减少当前二维分类中已知的变异性。
III级，回顾性比较研究的系统评价。
