Zhu Ce, Yang Xi, Zhou Bangjian, Wang Lei, Zhou Chunguang, Ling Tingxian, Liu Limin, Song Yueming
Department of Orthopedics Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan, 610041, China.
BMC Musculoskelet Disord. 2017 May 25;18(1):220. doi: 10.1186/s12891-017-1590-5.
Several studies have explored cervical kyphosis (CK) in adolescent idiopathic scoliosis (AIS) patients. However, few studies have evaluated the cervical alignment in these patients according to their coronal curve type. The aim of this study was to analyze the radiological features of cervical sagittal alignment in Lenke 1 AIS patients before and after surgery.
This is a retrospective study enrolled 50 patients. Preoperative and postoperative standing full-length radiographs (at last follow-up after operation) were used to measure the coronal and sagittal parameters. Main sagittal parameters included C2-C7 angle, thoracic inlet angle (TIA), T1 slope, proximal thoracic kyphosis (PTK, T1-5 kyphosis) and thoracic kyphosis (TK, T5-12 kyphosis).
The TIA of patients with CK was significantly smaller than that of patients with CL (63.0° vs. 76.3°, p < 0.05) and the cutoff value was 71°. The TIA of patients with CK after surgery was significantly smaller than that of patients with CL postoperatively (62.5° vs. 74.6°, p < 0.05) and the cutoff value was 62°. In patients with postoperative CL, there was a significant increase in their PTK and a reduction in their TK, regardless of preoperative CL or CK. In patients whose CL deteriorated to CK after surgery, both their PTK and TK significantly decreased after surgery.
Patients with TIA less than 71° were more likely to have CK. And patients with TIA less than 62° would lead to the postoperative uncorrected or new onset of CK. The increased PTK after operation could have a beneficial effect on the improvement of CL.
多项研究探讨了青少年特发性脊柱侧凸（AIS）患者的颈椎后凸（CK）情况。然而，很少有研究根据这些患者的冠状面曲线类型评估其颈椎排列情况。本研究的目的是分析Lenke 1型AIS患者手术前后颈椎矢状面排列的影像学特征。
这是一项纳入50例患者的回顾性研究。术前和术后站立位全长X线片（术后最后一次随访时）用于测量冠状面和矢状面参数。主要矢状面参数包括C2-C7角、胸廓入口角（TIA）、T1斜率、近端胸椎后凸（PTK，T1-5后凸）和胸椎后凸（TK，T5-12后凸）。
CK患者的TIA显著小于颈椎前凸（CL）患者（63.0°对76.3°，p<0.05），截断值为71°。术后CK患者的TIA显著小于术后CL患者（62.5°对74.6°，p<0.05），截断值为62°。在术后CL患者中，无论术前是CL还是CK，其PTK均显著增加，TK均降低。在术后CL恶化为CK的患者中，术后PTK和TK均显著降低。
TIA小于71°的患者更易发生CK。TIA小于62°的患者会导致术后CK未矫正或新发。术后PTK增加可能对CL的改善有有益作用。
