Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
Spine (Phila Pa 1976). 2010 Aug 15;35(18):E882-8. doi: 10.1097/brs.0b013e3181d6fdd7.
An association study between radiologic measurements and cosmetic appearance in adolescent idiopathic scoliosis (AIS) patients with Lenke 5 and 6 curve types.
The present study aimed at investigating the correlation between radiologic measurements and clinical cosmetic assessment indices in AIS with Lenke 5 and 6 curve types.
Cosmetic truncal and pelvic distortions are of important concern to patients with AIS. In the clinical assessment of AIS, over reliance on radiologic evaluations without corresponding objective assessment of the external physical appearance is commonly practiced. Patients having the same radiologic findings could be quite different in their physical appearance and the reverse could also happen. These observations imply that discrepancies could well exist in the cosmetic versus radiologic evaluation in AIS.
A total of 52 AIS patients with dominant lumbar/thoracolumbar curve including 36 Lenke type 5 and 16 Lenke type 6 were recruited. Cobb angles, coronal balance, thoracic containment, apical vertebral translation (AVT), pelvic oblique, apical vertebral rotation were measured in the standard long-standing posteroanterior radiographs. Waistline Height Index, Waistline Depth Index, Waistline Area Index, Waist Area Index, and hump index (α) were measured clinically and the 5 parameters combined into a composite cosmetic Index (CCI). Pearson rank correlation coefficient was used to assess measurement reliability for the cosmetic indices; correlation analysis and multiple linear regression analysis were made between the radiologic measurements and CCI.
The correlation coefficients between radiologic measurements and CCI ranged from -0.29 to 0.57, among which AVT was found to have the highest correlation coefficient, but not the Cobb angle. AVT, Cobb angle, coronal balance, thoracic containment were found to be significantly correlated with CCI (P < 0.05) with all correlation coefficients below 0.6. From linear regression analysis, CCI could be predicted by the equation (CCI = 98.0-1.18 x AVT-0.29 x Cobb angle) with adjusted R2 of 0.33 (implying that 33% of CCI variation could be accounted for by Cobb angle and AVT).
The present study showed that a number of radiologic indices could only partially reflect the objective cosmetic appearances in Lenke type 5 and 6 curves in AIS. Spine surgeons should put more emphasis in the clinical cosmetic evaluations and not relying solely on the radiologic assessment in AIS.
青少年特发性脊柱侧凸（AIS）Lenke 5 型和 6 型患者的放射学测量与美容外观的相关性研究。
本研究旨在探讨 Lenke 5 型和 6 型 AIS 患者放射学测量与临床美容评估指标之间的相关性。
脊柱侧凸患者的躯干和骨盆美容畸形是其关注的重要问题。在 AIS 的临床评估中，通常过度依赖放射学评估，而不对应地评估外部物理外观。具有相同放射学发现的患者在外观上可能存在很大差异，反之亦然。这些观察结果表明，AIS 中的美容与放射学评估之间可能存在差异。
共纳入 52 例主胸腰段脊柱侧凸的 AIS 患者，其中 36 例为 Lenke 5 型，16 例为 Lenke 6 型。在标准的直立前后位 X 线片上测量 Cobb 角、冠状平衡、胸椎包容、顶椎椎体平移（AVT）、骨盆倾斜、顶椎椎体旋转。临床测量腰围高度指数、腰围深度指数、腰围面积指数、腰围面积指数和驼峰指数（α），并将 5 项参数组合成复合美容指数（CCI）。采用 Pearson 秩相关系数评估美容指标的测量可靠性；对放射学测量值与 CCI 进行相关性分析和多元线性回归分析。
放射学测量值与 CCI 的相关系数范围为-0.29 至 0.57，其中 AVT 具有最高的相关系数，但不是 Cobb 角。AVT、Cobb 角、冠状平衡、胸椎包容与 CCI 显著相关（P<0.05），所有相关系数均低于 0.6。线性回归分析表明，CCI 可由以下方程预测（CCI=98.0-1.18×AVT-0.29×Cobb 角），调整 R2为 0.33（意味着 Cobb 角和 AVT 可解释 33%的 CCI 变化）。
本研究表明，一些放射学指标只能部分反映 AIS Lenke 5 型和 6 型曲线的客观美容外观。脊柱外科医生应更加重视临床美容评估，而不仅仅依赖于 AIS 的放射学评估。
