Interdisciplinary Division of Biomedical Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
Spine (Phila Pa 1976). 2018 Feb 15;43(4):E250-E258. doi: 10.1097/BRS.0000000000002276.
A literature review.
The aim of this study was to review the contemporary methods for spinal flexibility assessment on the patients with adolescent idiopathic scoliosis (AIS).
Spinal flexibility is one of the essential parameters for clinical decisions on the patients with AIS. Various methods of spinal flexibility assessment are proposed, but which method(s) could better reveal spinal flexibility or predict treatment effect is unclear.
The databases of AbleData, IBSS, Academic Search Premier, MEDLINE/PubMed, CINAHL, Recal Legacy, REHABDATA, Embase, and Web of Science were searched. The study inclusive criteria were (1) prospective cohort study; (2) investigated spinal flexibility on AIS patients; (3) published in English 1996 to 2016.
Totally 15 articles were included and 11 methods of spinal flexibility assessment were introduced in this review. Traction methods revealed higher spinal flexibility on the patients with severe curves (>65°) but lower spinal flexibility on the patients with moderate curves (40°-65°), comparing with lateral bending methods. Among lateral bending methods, fulcrum bending flexibility is higher on thoracic (T) curves, whereas supine with lateral bending flexibility is higher on thoracolumbar or lumbar (TL/L) curves. For predicting postoperative correction, fulcrum bending flexibility showed higher correlation with postoperative correction on moderate curves and traction flexibility showed higher correlation on severe curves, compared with supine with lateral bending method.
Curve magnitude and location are two important parameters in selecting appropriate method for spinal flexibility assessment and treatment effect prediction. The traction method should be considered for the patients with severe curves, while the lateral bending method is suggested for the patients with moderate curves. The fulcrum bending method is recommended to assess T curve flexibility, whereas the supine with lateral bending method is for the assessment of TL/L curve flexibility. A comprehensive guideline for selecting spinal flexibility assessment method(s) should be established via future studies.
文献回顾。
本研究旨在回顾青少年特发性脊柱侧凸（AIS）患者脊柱柔韧性评估的当代方法。
脊柱柔韧性是 AIS 患者临床决策的重要参数之一。已经提出了各种脊柱柔韧性评估方法，但哪种（或哪些）方法能更好地揭示脊柱柔韧性或预测治疗效果尚不清楚。
检索了 AbleData、IBSS、Academic Search Premier、MEDLINE/PubMed、CINAHL、Recal Legacy、REHABDATA、Embase 和 Web of Science 数据库。本研究的纳入标准为：（1）前瞻性队列研究；（2）研究 AIS 患者脊柱柔韧性；（3）1996 年至 2016 年以英文发表的文献。
共纳入 15 篇文献，介绍了 11 种脊柱柔韧性评估方法。与侧屈方法相比，牵引方法在重度曲度（>65°）患者中显示出更高的脊柱柔韧性，而在中度曲度（40°-65°）患者中显示出较低的脊柱柔韧性。在侧屈方法中，胸弯（T 弯）的支点弯曲柔韧性较高，而仰卧位侧屈柔韧性在胸腰段或腰椎段（TL/L 弯）较高。对于预测术后矫正，中度曲度患者的支点弯曲柔韧性与术后矫正的相关性较高，重度曲度患者的牵引柔韧性与术后矫正的相关性较高，而仰卧位侧屈法则相关性较低。
曲度大小和部位是选择脊柱柔韧性评估和治疗效果预测的合适方法的两个重要参数。对于重度曲度患者，应考虑牵引法，而对于中度曲度患者，建议采用侧屈法。推荐使用支点弯曲法评估 T 弯柔韧性，而仰卧位侧屈法适用于 TL/L 弯柔韧性的评估。应通过未来的研究制定选择脊柱柔韧性评估方法的综合指南。
4 级。
