Department of Orthopedic Surgery, Rady Children's Hospital, 3030 Children's Way, Suite 410, San Diego, CA 92123. E-mail address for P.O. Newton:
Department of Orthopedic Surgery, Sumitomo Hospital, 5-3-20 Nakanoshima, Kita Ward, Osaka, Osaka Prefecture 530-0005, Japan.
J Bone Joint Surg Am. 2015 Oct 21;97(20):1694-701. doi: 10.2106/JBJS.O.00148.
BACKGROUND: Obtaining accurate measurements of scoliosis from two-dimensional (2-D) radiographs can be challenging because of the three-dimensional (3-D) nature of the deformity. Previous studies have shown that the sagittal plane, in particular, is misrepresented on 2-D radiographs because of the influence of axial plane rotation. The purpose of the current study was to define a methodology for measuring the 3-D segmental sagittal alignment of the spine in patients with adolescent idiopathic scoliosis (AIS) and to assess the effect of axial plane rotation on differences between 3-D and 2-D measures of deformity. METHODS: Preoperative and postoperative EOS images of 120 consecutive patients with AIS (primary thoracic curves) treated with segmental thoracic pedicle-screw instrumentation were analyzed in the "3-D sagittal plane." The technique measured 3-D kyphosis or lordosis in the specific plane of sagittal motion for each spinal motion segment. The kyphosis (+) and lordosis (-) values of the segments from T5 to T12 were summed to give the 3-D measurement of T5-T12 kyphosis. These values were compared with the standard 2-D measurements of T5-T12 kyphosis on lateral radiographs, and a correlation analysis with regard to axial plane rotation of the apex was performed. RESULTS: The average age (and standard deviation) of the patients was 14 ± 2 years. The mean preoperative Cobb angle on the standard 2-D view was 55° ± 10° and on the 3-D view was 52° ± 9° (p ≤ 0.001). On the 3-D view, the mean preoperative T5-T12 kyphosis was 6° ± 14°, and the kyphosis significantly increased to 26° ± 6° postoperatively (p < 0.001). The T5-T12 kyphosis on the standard 2-D view measured 18° ± 13° preoperatively and 27° ± 6° postoperatively (p < 0.001). The difference between the 2-D and 3-D measurements of T5-T12 kyphosis strongly correlated with apical vertebral rotation (r = 0.85; p < 0.01). CONCLUSIONS: Routine 2-D measurements of thoracic kyphosis erroneously underestimate the preoperative loss of kyphosis in AIS because of errors associated with axial plane rotation, an inherent component of thoracic scoliosis.
背景：由于脊柱畸形的三维性质，从二维（2-D）射线照片中准确测量脊柱侧弯可能具有挑战性。先前的研究表明，由于轴向平面旋转的影响，矢状面特别是在 2-D 射线照片上被错误表示。本研究的目的是定义一种测量青少年特发性脊柱侧凸（AIS）患者脊柱三维节段矢状排列的方法，并评估轴向平面旋转对畸形的 3-D 和 2-D 测量值之间差异的影响。
方法：对 120 例接受节段性胸椎椎弓根螺钉固定治疗的 AIS（原发性胸椎曲线）患者的术前和术后 EOS 图像进行了分析，这些患者被分析在“3-D 矢状面”。该技术测量了每个脊柱运动节段特定矢状运动平面的 3-D 后凸或前凸。将 T5 到 T12 的节段的后凸（+）和前凸（-）值相加，得到 T5-T12 后凸的 3-D 测量值。将这些值与侧位射线照片上的标准 2-D T5-T12 后凸测量值进行比较，并对顶点的轴向平面旋转进行相关性分析。
结果：患者的平均年龄（和标准差）为 14 ± 2 岁。标准 2-D 视图上的平均术前 Cobb 角为 55°±10°，3-D 视图上为 52°±9°（p≤0.001）。在 3-D 视图上，术前 T5-T12 后凸的平均值为 6°±14°，术后增加至 26°±6°（p<0.001）。标准 2-D 视图上术前 T5-T12 后凸测量值为 18°±13°，术后为 27°±6°（p<0.001）。2-D 和 3-D T5-T12 后凸测量值之间的差异与顶椎旋转强烈相关（r=0.85；p<0.01）。
结论：由于与胸弯固有成分的轴向平面旋转相关的误差，常规 2-D 测量胸椎后凸会错误地低估 AIS 术前后凸的丢失。
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