Menon Venugopal K, Tahasildar Naveen, Pillay Haroon M, M Anbuselvam
*Department of Orthopaedics, Khoula Hospital, Mina al Fahal, Muscat, Sultanate of Oman †Department of Orthopaedics, Sparsh Hospital, Bangalore, India ‡Department of Neurosurgery, RIPAS Hospital, Bandar Seri Begawan, Brunei.
Clin Spine Surg. 2017 May;30(4):E351-E357. doi: 10.1097/BSD.0000000000000193.
Prospective observational study.
To study axial plane deformation of the shoulder in adolescent idiopathic scoliosis (AIS) and try to correlate it with curve type and surgical correction.
It is established that AIS is a 3-dimensional deformity. The rib hump is the most common manifestation of axial plane deformations; the least common manifestation seems to be upper trunk and shoulder rotation, which has been hitherto undescribed.
Fourteen consecutive, operated cases of AIS were analyzed prospectively. Preoperative and postoperative x-rays of the spine and clinical photographs were studied. Clinical photographs (top view) were taken with patients in the sitting position, to show shoulder level in relation to the axis of the head and pelvis. Chest computed tomography scans were also studied to determine the direction of apical vertebra and trunk torsion.
All 14 patients in this series had their right shoulders anteriorly rotated preoperatively (anticlockwise). The direction of rotation seemed unrelated to the curve type and shoulder elevation, although most had rib humps on the right. This shoulder rotation was corrected postoperatively by routine maneuvers done for scoliosis correction. Minor residual rotation was seen in 6 patients who also had minimal persisting rib hump. In 1 case the axial plane rotation worsened, although the shoulder level and trunk symmetry improved significantly. The apical vertebral rotation on computed tomography had little bearing on the direction of shoulder rotation.
Axial plane rotation of the shoulder is a hitherto un-described dimension of AIS deformity complex. Much of it corrects spontaneously with correction of the thoracic spinal deformity.
前瞻性观察性研究。
研究青少年特发性脊柱侧凸（AIS）患者肩部矢状面变形情况，并尝试将其与侧弯类型及手术矫正效果相关联。
已证实AIS是一种三维畸形。肋骨隆凸是矢状面变形最常见的表现；最不常见的表现似乎是上躯干和肩部旋转，此前尚未见相关描述。
对14例连续接受手术的AIS病例进行前瞻性分析。研究脊柱的术前和术后X线片以及临床照片。临床照片（顶视图）在患者坐位时拍摄，以显示肩部相对于头部和骨盆轴线的水平。还研究了胸部计算机断层扫描以确定顶椎方向和躯干扭转情况。
本系列14例患者术前均有右肩向前旋转（逆时针方向）。旋转方向似乎与侧弯类型和肩部抬高无关，尽管大多数患者右侧有肋骨隆凸。这种肩部旋转在脊柱侧凸矫正的常规操作后术后得到矫正。6例患者有轻微残余旋转，同时肋骨隆凸残留也最少。1例患者矢状面旋转加重，尽管肩部水平和躯干对称性显著改善。计算机断层扫描显示的顶椎旋转与肩部旋转方向关系不大。
肩部矢状面旋转是AIS畸形复合体中一个此前未被描述的维度。随着胸椎畸形的矫正，大部分会自然矫正。
