Department of Orthopedic Surgery, Faculty of Medicine, the University of Tokyo, Tokyo, Japan.
Spine (Phila Pa 1976). 2012 Nov 15;37(24):E1511-6. doi: 10.1097/BRS.0b013e31826e2bbb.
A single-center prospective case series.
To examine 2 features of shoulder asymmetry (clavicle tilt and trapezial prominence) and their correlation with radiographical parameters.
Shoulder imbalance is one of the more notable aspects of clinical deformity due to scoliosis. However, a discrepancy between radiographical and clinical shoulder balance in patients with adolescent idiopathic scoliosis (AIS) has been reported.
A consecutive series of 113 preoperative right main thoracic Lenke 1 and 2 AIS curves were included. Clavicle angle (tilt), trapezial angle, and ratio of left to right trapezial area were measured on clinical photos. These were correlated with radiographical measurements of T1 tilt, first rib angle, curve magnitudes, and thoracic and lumbar apical translation to C7 plumb line and center sacral vertical line.
The average age was 14.1 years. There were 82 Lenke 1 and 31 Lenke 2 curves with an average thoracic Cobb of 52.1º. The clinical clavicle angle was in the range of -10.6º to +5.2º ("+" defined as high on the left) and had modest correlation with T1 tilt, thoracic curve size, and thoracic apical deviation (r = 0.417, 0.437, and 0.408, respectively). Medial shoulder trapezial prominence as measured by the trapezial angle (range: -16.7 to +9.9) and trapezial area ratio (natural log of ratio range: -1.15 to +0.80) correlated well with the radiographical measurements of T1 tilt, first rib angle, and upper thoracic curve size (trapezial angle: 0.713, 0.679, and 0.686; trapezial area ratio: 0.597, 0.595, and 0.653, respectively).
Our analysis suggests that there are 2 distinct regions (lateral and medial) of shoulder height asymmetry. Medial differences reflected in trapezial prominence relate to deformity created by upward tilted proximal ribs and T1 tilt. Lateral differences in shoulder symmetry as reflected in the clavicle angle correlate weakly with radiographical measures. This suggests that correction of trapezial prominence may be more predictable compared with clavicle angulation after scoliosis surgery.
单中心前瞻性病例系列研究。
检查肩部不对称的两个特征（锁骨倾斜和斜方肌突出）及其与影像学参数的相关性。
由于脊柱侧弯，肩部不平衡是临床畸形的一个较为显著的方面。然而，已报道青少年特发性脊柱侧弯（AIS）患者的影像学和临床肩部平衡之间存在差异。
连续纳入 113 例术前右主胸 Lenke 1 和 2 型 AIS 曲线的患者。在临床照片上测量锁骨角（倾斜）、斜方肌角和左右斜方肌面积比。这些参数与 T1 倾斜、第一肋角、曲线大小以及胸腰椎顶椎向 C7 铅垂线和中矢状线的平移进行相关性分析。
平均年龄为 14.1 岁。82 例 Lenke 1 型和 31 例 Lenke 2 型曲线，胸段 Cobb 角平均为 52.1°。临床锁骨角的范围为-10.6°至+5.2°（“+”定义为左侧高），与 T1 倾斜、胸段曲线大小和胸段顶点偏移有中度相关性（r = 0.417、0.437 和 0.408）。通过斜方肌角（范围：-16.7 至+9.9）和斜方肌面积比（自然对数比值范围：-1.15 至+0.80）测量的内侧肩部斜方肌突出与 T1 倾斜、第一肋角和上胸段曲线大小的影像学测量值密切相关（斜方肌角：0.713、0.679 和 0.686；斜方肌面积比：0.597、0.595 和 0.653）。
我们的分析表明，肩部高度不对称有 2 个不同的区域（外侧和内侧）。反映在斜方肌突出的内侧差异与近端肋骨向上倾斜和 T1 倾斜所造成的畸形有关。锁骨角反映的肩部对称性的外侧差异与影像学测量值弱相关。这表明与脊柱侧弯手术后的锁骨角度相比，斜方肌突出的矫正可能更具可预测性。
