Matamalas Antonia, Bagó Juan, D'Agata Elisabetta, Pellisé Ferran
Service of Orthopaedic Surgery and Traumatology, Hospital Vall d'Hebrón, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain.
Institute of Research Hospital Vall d'Hebrón, Passeig de la Vall d'Hebron 119, 08035, Barcelona, Spain.
Eur Spine J. 2016 Nov;25(11):3560-3567. doi: 10.1007/s00586-015-3971-5. Epub 2015 Apr 24.
To evaluate the relationship between radiological, clinical and perceived shoulder balance (ShB) in a sample of non-operated, moderate, idiopathic scoliosis (IS) patients.
80 patients (85 % women) with a mean age of 20.3 years (SD 8.6, 12-40 years) were included. Mean Cobb angle was 45.9° (SD 12.9, 25.1°-77.2°). All patients had full spine X-ray and a digital photography from the front. To determine clinical ShB, shoulder height angle (SHA) and axilla height angle (AHA) were measured on clinical photographs. Radiological ShB was assessed with the clavicle-rib intersection angle and T1-tilt. Patients also completed different patient-reported outcomes (PRO) instruments: SRS-22, TAPS and Spinal Appearance Questionnaire (SAQ). SAQ included two questions concerning the shoulder area (SAQ-6 = perception and SAQ-13 = expectation) which were used to assess perceived ShB. Patients were divided into two groups: balanced (SHA <3.0°), and imbalanced (SHA ≥3.0°) according to minimal detectable change of SHA. The correlations between variables and mean differences between the two groups were analyzed.
No statistically significant correlations were found between clinical (SHA and AHA) and perceived ShB (SAQ-6), or with PRO scores. 62.5 % of patients were in the "Balanced" group. 46.6 % (14/30) of patients in the clinically imbalanced group (≥3.0°) perceive themselves as totally balanced (score 1 and 2 in SAQ-6), while 10 % (5/50) of patients in the balanced group (SHA <3.0°) perceive themselves as totally imbalanced (score 4 and 5 in SAQ-13). No differences were found between both groups in terms of radiological and perceived ShB, or in PRO scores.
We have not found a significant correlation between clinical/radiological ShB and perceived ShB in non-operated IS patients. It seems that ShB is not a key factor in patient trunk deformity perception. In addition, patient expectations regarding improvement with treatment are not directly related to actual clinical imbalance.
评估非手术治疗的中度特发性脊柱侧凸（IS）患者样本中放射学、临床及感知到的肩部平衡（ShB）之间的关系。
纳入80例患者（85%为女性），平均年龄20.3岁（标准差8.6，12 - 40岁）。平均Cobb角为45.9°（标准差12.9，25.1° - 77.2°）。所有患者均拍摄了全脊柱X线片及正位数码照片。为确定临床ShB，在临床照片上测量肩高角（SHA）和腋窝高角（AHA）。通过锁骨 - 肋骨交叉角和T1倾斜度评估放射学ShB。患者还完成了不同的患者报告结局（PRO）工具：SRS - 22、TAPS和脊柱外观问卷（SAQ）。SAQ包括两个关于肩部区域的问题（SAQ - 6 = 感知，SAQ - 13 = 期望），用于评估感知到的ShB。根据SHA的最小可检测变化，将患者分为两组：平衡组（SHA <3.0°）和不平衡组（SHA≥3.0°）。分析两组之间变量的相关性及均值差异。
未发现临床（SHA和AHA）与感知到的ShB（SAQ - 6）之间或与PRO评分之间存在统计学显著相关性。62.5%的患者属于“平衡”组。临床不平衡组（≥3.0°）中有46.6%（14/30）的患者认为自己完全平衡（SAQ - 6评分为1和2），而平衡组（SHA <3.0°）中有10%（5/50）的患者认为自己完全不平衡（SAQ - 13评分为4和5）。两组在放射学和感知到的ShB方面或PRO评分方面均未发现差异。
在非手术治疗的IS患者中，我们未发现临床/放射学ShB与感知到的ShB之间存在显著相关性。似乎ShB不是患者躯干畸形感知的关键因素。此外，患者对治疗改善的期望与实际临床不平衡没有直接关系。
