Diebo Bassel G, Gammal Isaac, Ha Yoon, Yoon Seung Hwan, Chang Jae Won, Kim Byeongwoo, Matsumoto Morio, Yamato Yu, Takeuchi Daisaku, Hosogane Naobumi, Yagi Mitsuru, Taneichi Hiroshi, Schwab Frank, Lafage Virginie, Ames Christopher
Spine Service, Hospital for Special Surgery, New York, NY.
Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, NY.
Spine (Phila Pa 1976). 2017 Feb 15;42(4):E234-E240. doi: 10.1097/BRS.0000000000001744.
Retrospective review of adult spinal deformity patients in a multiethnic database.
To investigate the role of ethnicity on recruitment of compensatory mechanisms for sagittal spinal deformity.
While the impacts of age, sex, and pelvic morphology on the ability to compensate for sagittal malalignment have been investigated, the role of ethnicity in compensatory mechanism recruitment is poorly understood.
Patients from USA (85% Caucasian) >25 y/o were propensity matched by age, sex, and pelvic incidence with patients from Korea and Japan. Only primary patients or those with existing fusion below T12 were retained for analysis. Groups were subclassified by deformity severity (aligned: sagittal vertical axis (SVA) <50 mm; moderate malalignment: SVA 50-100 mm; severe malalignment: SVA >100 mm). Radiographic measurements including pelvic retroversion, thoracic kyphosis, loss of lumbar lordosis (PI minus LL), cervical lordosis, and cervical SVA were compared between the groups.
There were 288 patients (96 each in USA, KOR, JPN), with similar age (64-67 yr) and PI (49-53°). USA had smaller pelvic incidence minus lumbar lordosis in every alignment group (P <0.05). In moderate malalignment, JPN had more pelvic retroversion than USA (30° vs. 20°), and KOR had more thoracic hypokyphosis than USA (15 vs. 31°). In severe malalignment, JPN had more pelvic retroversion than USA (39° vs. 27°), and KOR had more thoracic hypokyphosis than USA (15° vs. 31°). KOR had smaller cSVA than USA in both aligned (11 vs. 27 mm) and moderate (19 vs. 31 mm) malalignment. In severe malalignment, KOR had less cervical lordosis (13° KOR vs. 15° USA vs. 27° JPN). All differences with P <0.05.
Compensation for sagittal is ethnicity dependent. Korean patients favor thoracic compensation via hypokyphosis, and Japanese patients favor pelvic compensation via retroversion. Patient ethnicity should be considered when evaluating the sagittal plane and surgical correction strategies.
对一个多民族数据库中的成人脊柱畸形患者进行回顾性研究。
探讨种族因素在矢状面脊柱畸形代偿机制募集方面的作用。
虽然年龄、性别和骨盆形态对矢状面排列不齐代偿能力的影响已得到研究，但种族因素在代偿机制募集中的作用仍知之甚少。
将来自美国（85%为白种人）年龄大于25岁的患者与来自韩国和日本的患者按年龄、性别和骨盆倾斜角进行倾向匹配。仅保留初次就诊患者或T12以下已有融合的患者用于分析。根据畸形严重程度对各组进行亚分类（排列整齐：矢状垂直轴（SVA）<50mm；中度排列不齐：SVA 50 - 100mm；重度排列不齐：SVA>100mm）。比较各组之间包括骨盆后倾、胸椎后凸、腰椎前凸丢失（骨盆入射角减去腰椎前凸）、颈椎前凸和颈椎SVA在内的影像学测量结果。
共有288例患者（美国、韩国、日本各96例），年龄（64 - 67岁）和骨盆入射角（49 - 53°）相似。在每个排列不齐组中，美国患者的骨盆倾斜角减去腰椎前凸值均较小（P<0.05）。在中度排列不齐组中，日本患者的骨盆后倾程度大于美国患者（30°对20°），韩国患者的胸椎后凸不足程度大于美国患者（15°对31°）。在重度排列不齐组中，日本患者的骨盆后倾程度大于美国患者（39°对27°），韩国患者的胸椎后凸不足程度大于美国患者（15°对31°）。在排列整齐组（11mm对27mm）和中度排列不齐组（19mm对31mm）中，韩国患者的颈椎SVA均小于美国患者。在重度排列不齐组中，韩国患者的颈椎前凸程度小于美国患者（韩国13°，美国15°，日本27°）。所有差异P<0.05。
矢状面的代偿存在种族依赖性。韩国患者倾向于通过胸椎后凸不足进行代偿，日本患者倾向于通过骨盆后倾进行代偿。在评估矢状面和手术矫正策略时应考虑患者的种族因素。
3级。
