Pizones Javier, Núñez-Medina Alberto, Sánchez-Mariscal Felisa, Zúñiga Lorenzo, Izquierdo Enrique
Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario de Getafe, Carretera de Toledo Km. 12.5, 28905, Madrid, Spain.
Eur Spine J. 2016 Oct;25(10):3095-3103. doi: 10.1007/s00586-016-4400-0. Epub 2016 Jan 28.
PURPOSE: To analyze the sagittal thoracic parameters of different types of progressive thoracic adolescent idiopathic scoliosis (AIS) patients and compare them with healthy adolescents. METHODS: 115 AIS patients with main thoracic curves (Cobb: 59.4 ± 12.7) were prospectively compared with 116 healthy adolescents. The AIS and control (C) groups were homogeneous in terms of age and gender. Standing sagittal radiographs were analyzed for differences in T5-T12 kyphosis, T5-T8 and T9-T12 segmental kyphosis, the change between these two angles, and the double rib contour sign. Statistical analyses were performed using the χ , one-way ANOVA, Mann-Whitney U and Student's t tests. RESULTS: The sagittal parameters of Lenke 1 curves did not differ from healthy adolescents (T5-T8: 17.1 ± 10 vs C: 16 ± 7; T9-T12: 6.3 ± 7 vs C: 7.9 ± 5; T5-T12: 23.9 ± 14 vs C: 23.9 ± 8). Compared with the controls, Lenke type 3 curves were globally more hypokyphotic (T5-T12: 18.9 ± 12 vs C: 23.9 ± 8, P = 0.027) due to a "lordosis" of the lower thoracic segment (T9-T12: 0.9 ± 10 vs C: 7.9 ± 5, P = 0.001). Type 2 curves tended to exhibit more pronounced upper thoracic kyphosis (T5-T8: 20.7 ± 12 vs C: 16 ± 7). Both types 2 and 3 require a marked TK changes in the transition between the upper and lower thoracic segments to compensate for global (T5-T12) kyphosis. CONCLUSIONS: In this 2D analysis of moderate AIS, Lenke 1 curves exhibited normal thoracic sagittal parameters, which brings into question the effect of lordosis on the development of single thoracic curves. Lenke 3 curves exhibited lower thoracic segmental hypokyphosis, and the type 2 showed upper segmental hyperkyphosis. These results should be considered when planning a surgical strategy.
目的:分析不同类型的进行性胸椎青少年特发性脊柱侧凸(AIS)患者的胸椎矢状面参数,并与健康青少年进行比较。 方法:前瞻性地比较了115例主胸弯(Cobb角:59.4±12.7)的AIS患者和116例健康青少年。AIS组和对照组(C组)在年龄和性别方面具有同质性。分析站立位矢状面X线片上T5-T12后凸角、T5-T8和T9-T12节段性后凸角、这两个角度之间的变化以及双肋轮廓征的差异。采用χ²检验、单因素方差分析、Mann-Whitney U检验和Student's t检验进行统计学分析。 结果:Lenke 1型曲线的矢状面参数与健康青少年无差异(T5-T8:17.1±10 vs C组:16±7;T9-T12:6.3±7 vs C组:7.9±5;T5-T12:23.9±14 vs C组:23.9±8)。与对照组相比,Lenke 3型曲线整体后凸角度更小(T5-T12:18.9±12 vs C组:23.9±8,P=0.027),这是由于胸下段(T9-T12)出现“前凸”(T9-T12:0.9±10 vs C组:7.9±5,P=0.001)。2型曲线往往表现出更明显的胸上段后凸(T5-T8:20.7±12 vs C组:16±7)。2型和3型曲线在上胸段和下胸段过渡处都需要明显的胸腰段后凸变化来代偿整体(T5-T12)后凸。 结论:在这项对中度AIS的二维分析中,Lenke 1型曲线表现出正常的胸椎矢状面参数,这使人质疑前凸对单胸弯发展的影响。Lenke 3型曲线表现出胸下段节段性后凸减小,2型表现出胸上段节段性后凸增加。在制定手术策略时应考虑这些结果。
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