脊柱柔韧性的生物力学建模及其与脊柱活动度和特发性脊柱侧弯的关系
Biomechanical Modeling of Spine Flexibility and Its Relationship to Spinal Range of Motion and Idiopathic Scoliosis.
作者信息
Wren Tishya A L, Ponrartana Skorn, Poorghasamians Ervin, Moreau Sarah, Aggabao Patricia C, Zaslow Tracy L, Edison Bianca R, Gilsanz Vicente
机构信息
Department of Radiology, Children's Hospital Los Angeles, MS #81, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA; Children's Orthopaedic Center, Division of Orthopaedic Surgery, Children's Hospital Los Angeles, MS #69, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
Department of Radiology, Children's Hospital Los Angeles, MS #81, Keck School of Medicine, University of Southern California, Los Angeles, CA 90027, USA.
出版信息
Spine Deform. 2017 Jul;5(4):225-230. doi: 10.1016/j.jspd.2017.01.007.
STUDY DESIGN
Cross-sectional.
OBJECTIVE
To examine the relationships between spine morphology, spine flexibility, and idiopathic scoliosis.
BACKGROUND
Girls have a higher incidence of clinically significant scoliosis than boys, along with smaller vertebrae and greater flexibility. Based on biomechanical modeling, we hypothesized that smaller vertebral width relative to intervertebral disc (IVD) height would be associated with both greater lateral flexibility of the spine and with idiopathic scoliosis.
METHODS
Magnetic resonance imaging was used to measure IVD height, vertebral width, and paraspinous musculature in 22 girls with mild and moderate idiopathic scoliosis and 29 girls without scoliosis ages 9-13 years. Clinical measurement of maximum lateral bending was also performed in the girls without scoliosis. A simple biomechanical model was used to estimate bending angle from the ratio of IVD height to vertebral half-width for L1-L4. The average ratio (R) and calculated total bending angle (α) for L1-L4 were compared to the clinical measurements of lateral bending flexibility in the control group. These measures were also compared between the scoliosis and control groups.
RESULTS
There was a significant positive relationship between clinical flexibility and both R (p = .041) and α (p = .042) adjusting for skeletal age, height, body mass index, and paraspinous muscle area as covariates. The ratio was significantly higher (R = 0.45 vs. 0.38, p < .0001) and the bending angle was significantly greater (α = 107° vs. 89°, p < .0001) for girls with scoliosis compared with controls.
CONCLUSION
These results suggest that differences in spine morphology and corresponding changes in spine flexibility may be related to idiopathic scoliosis. If these relationships can be corroborated in larger prospective studies, these easily measured morphologic traits may contribute to a better understanding of the etiology of idiopathic scoliosis and an improved ability to predict scoliosis progression.
LEVEL OF EVIDENCE
Level III.
研究设计
横断面研究。
目的
研究脊柱形态、脊柱柔韧性与特发性脊柱侧凸之间的关系。
背景
女孩临床上显著脊柱侧凸的发病率高于男孩，同时其椎体较小且柔韧性更大。基于生物力学模型，我们假设相对于椎间盘（IVD）高度而言较小的椎体宽度与脊柱更大的侧向柔韧性以及特发性脊柱侧凸均相关。
方法
采用磁共振成像测量22例9至13岁轻度和中度特发性脊柱侧凸女孩以及29例无脊柱侧凸女孩的IVD高度、椎体宽度和椎旁肌肉组织。对无脊柱侧凸的女孩还进行了最大侧屈的临床测量。使用一个简单的生物力学模型根据L1 - L4的IVD高度与椎体半宽之比估算弯曲角度。将L1 - L4的平均比值（R）和计算出的总弯曲角度（α）与对照组的侧屈柔韧性临床测量值进行比较。还对脊柱侧凸组和对照组之间的这些测量值进行了比较。
结果
在校正骨骼年龄、身高、体重指数和椎旁肌肉面积作为协变量后，临床柔韧性与R（p = 0.041）和α（p = 0.042）之间存在显著正相关。与对照组相比，脊柱侧凸女孩的比值显著更高（R = 0.45对0.38，p < 0.0001），弯曲角度也显著更大（α = 107°对89°，p < 0.0001）。
结论
这些结果表明脊柱形态的差异以及脊柱柔韧性的相应变化可能与特发性脊柱侧凸有关。如果这些关系能在更大规模的前瞻性研究中得到证实，这些易于测量的形态学特征可能有助于更好地理解特发性脊柱侧凸的病因，并提高预测脊柱侧凸进展的能力。
证据水平
三级。
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