不同曲线进展的胸椎特发性脊柱侧凸患者矢状面轮廓的比较
[Comparison of the sagittal profiles between thoracic idiopathic scoliosis patients with different curve progression].
作者信息
Jiang Jun, Qiu Yong, Zhu Ze-zhang, Qian Bang-ping, Zhu Feng, Mao Sai-hu, Zhao Qing-hua
机构信息
Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China.
出版信息
Zhonghua Wai Ke Za Zhi. 2011 Sep 1;49(9):812-5.
OBJECTIVES
To compare the sagittal profiles between thoracic idiopathic scoliosis (IS) patients with different curve progression and to determine the risk factors associated with curve progression.
METHODS
A total of 83 thoracic IS patients from September 2009 to May 2010 were included in this study and were divided into 3 groups according to different curve progression. All the patients did not receive any previous treatments. There were 26 skeletally mature patients whose Risser sign were 5 degree with Cobb angle < 40° in non-curve progression group (NCP group), 29 mature patients whose Risser sign were 5 degree with Cobb angle ≥ 40° in moderate curve progression group (MCP group) and 28 immature patients whose Risser sign ≤ 3 degree with Cobb angle ≥ 40° in severe curve progression group (SCP group). Five sagittal parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI) and pelvic tilt (PT) were measured on the lateral X-ray films. Analysis of variance was used to compare these parameters among the 3 groups.
RESULTS
The average thoracic Cobb angle was significantly smaller in NCP group when compared with MCP group (P < 0.01) or SCP group (P < 0.01), but not significantly different between the 2 latter groups (P = 0.619). The average TK was 19° ± 7° in NCP group, 13° ± 6° in MCP group and 8° ± 5° in SCP group. The average TK was significantly smaller in SCP group when compared with MCP group (P = 0.011) or NCP group (P < 0.01), while the average TK was significantly smaller in MCP group when compared with NCP group (P < 0.01). None of the other 4 parameters showed any significant difference between the 3 groups (P > 0.05).
CONCLUSIONS
Thoracic hypokyphosis is strongly associated with curve progression in thoracic IS patients. Pelvic sagittal profile may not be involved in the underlying mechanism of curve progression in thoracic IS patients.
目的
比较不同曲线进展的胸椎特发性脊柱侧凸（IS）患者的矢状面轮廓，并确定与曲线进展相关的危险因素。
方法
本研究纳入了2009年9月至2010年5月期间的83例胸椎IS患者，并根据不同的曲线进展分为3组。所有患者此前均未接受过任何治疗。非曲线进展组（NCP组）有26例骨骼成熟患者，其Risser征为5度，Cobb角<40°；中度曲线进展组（MCP组）有29例成熟患者，其Risser征为5度，Cobb角≥40°；重度曲线进展组（SCP组）有28例未成熟患者，其Risser征≤3度，Cobb角≥40°。在侧位X线片上测量5个矢状面参数，包括胸椎后凸（TK）、腰椎前凸（LL）、骶骨倾斜度（SS）、骨盆入射角（PI）和骨盆倾斜度（PT）。采用方差分析比较3组之间的这些参数。
结果
与MCP组（P<0.01）或SCP组（P<0.01）相比，NCP组的平均胸椎Cobb角明显较小，但后两组之间无显著差异（P=0.619）。NCP组的平均TK为19°±7°，MCP组为13°±6°，SCP组为8°±5°。与MCP组（P=0.011）或NCP组（P<0.01）相比，SCP组的平均TK明显较小，而与NCP组相比，MCP组的平均TK明显较小（P<0.01）。其他4个参数在3组之间均无显著差异（P>0.05）。
结论
胸椎后凸不足与胸椎IS患者的曲线进展密切相关。骨盆矢状面轮廓可能不参与胸椎IS患者曲线进展的潜在机制。
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