Department of Orthopaedics, University Medical Center Utrecht, Utrecht, The Netherlands.
Spine (Phila Pa 1976). 2011 Apr 1;36(7):E486-91. doi: 10.1097/BRS.0b013e3181f468cc.
Vertebral rotation was systematically analyzed in the normal, nonscoliotic thoracic spine of children aged 0 to 16 years. Subgroups were created to match the infantile, juvenile, and adolescent age groups according to the criteria of the Scoliosis Research Society.
To determine whether a distinct pattern of vertebral rotation in the transverse plane exists in the normal, nonscoliotic infantile, juvenile, and adolescent spine.
We assume that, once the spine starts to deteriorate into a scoliotic deformity, it will follow a preexisting rotational pattern. Recently, we identified a rotational pattern in the normal nonscoliotic adult spine that corresponds to the most common curve types in adolescent idiopathic scoliosis. In infantile idiopathic scoliosis, curves are typically left sided and boys are affected more often than girls, whereas in adolescent idiopathic scoliosis, the thoracic curve is typically right sided and predominantly girls are affected. The present study is the first systematic analysis of vertebral rotation in the normal children's spine.
Vertebral rotation in the transverse plane of T2-T12 was measured by using a semiautomatic method on 146 computed tomographic scans of children (0-16 years old) without clinical or radiologic evidence of spinal pathology. Scans were mainly made for reasons such as recurrent respiratory tract infections, malignancies, or immune disorders. Vertebral rotational patterns were analyzed in the infantile (0-3-year-old), juvenile (4-9-year-old), and adolescent (10-16-year-old) boys and girls.
In the infantile spine, vertebrae T2-T6 were significantly rotated to the left (P < 0.001). In the juvenile spine, T4 was significantly rotated to the left. In the adolescent spine, T6-T12 were significantly rotated to the right (P ≤ 0.001). Rotation to the left was more pronounced in infantile boys than in the girls (P = 0.023). In juvenile and adolescent children, no statistical differences in rotation were found between the sexes.
These data support the hypothesis that the direction of the spinal curve in idiopathic scoliosis is determined by the built-in rotational pattern that the spine exhibits at the time of onset. The well-known predominance of right-sided thoracic curves in adolescent idiopathic scoliosis and left-sided curves in infantile idiopathic scoliosis can be explained by the observed patterns of vertebral rotation that preexist at the corresponding age.
系统分析了 0 至 16 岁非脊柱侧凸儿童正常胸段脊柱的椎体旋转。根据脊柱侧凸研究协会的标准，创建了亚组以匹配婴儿期、青少年期和青春期年龄组。
确定在正常非脊柱侧凸婴儿、青少年和青少年脊柱中是否存在横向平面中明显的椎体旋转模式。
我们假设，一旦脊柱开始恶化成脊柱侧凸畸形，它将遵循预先存在的旋转模式。最近，我们在正常非脊柱侧凸成人脊柱中发现了一种旋转模式，该模式与青少年特发性脊柱侧凸中最常见的曲线类型相对应。在婴儿特发性脊柱侧凸中，曲线通常是左侧，男孩比女孩更容易受影响，而在青少年特发性脊柱侧凸中，胸椎曲线通常是右侧，主要是女孩受影响。本研究是对正常儿童脊柱椎体旋转的首次系统分析。
使用半自动方法测量 146 例儿童（0-16 岁）的 T2-T12 椎体在横平面上的旋转，这些儿童没有临床或放射学证据表明有脊柱病理。扫描主要是由于复发性呼吸道感染、恶性肿瘤或免疫紊乱等原因进行的。分析了婴儿（0-3 岁）、青少年（4-9 岁）和青少年（10-16 岁）男孩和女孩的椎体旋转模式。
在婴儿脊柱中，T2-T6 椎体明显向左侧旋转（P <0.001）。在青少年脊柱中，T4 明显向左侧旋转。在青少年脊柱中，T6-T12 明显向右侧旋转（P ≤0.001）。与女孩相比，男婴的旋转更为明显（P =0.023）。在青少年和青少年儿童中，男女之间的旋转无统计学差异。
这些数据支持这样的假设，即特发性脊柱侧凸的脊柱曲线方向是由脊柱在发病时表现出的固有旋转模式决定的。众所周知，青少年特发性脊柱侧凸中右侧胸椎曲线的优势和婴儿特发性脊柱侧凸中左侧曲线可以用相应年龄存在的椎体旋转模式来解释。
