Department of Spine Surgery, The Affiliated Changzheng Hospital of The Second Military Medical University, Shanghai, China (mainland).
Department of Orthopedic Surgery, The Affiliated Changhai Hospital of The Second Military Medical University, Shanghai, China (mainland).
Med Sci Monit. 2017 Oct 18;23:4981-4988. doi: 10.12659/msm.903795.
BACKGROUND Flexibility evaluation methods were only used to assess the changes of coronal Cobb angle in patients with adolescent idiopathic scoliosis (AIS). Little attention was attached to the vertebral rotation in these methods. MATERIAL AND METHODS 21 patients with severe adolescent idiopathic scoliosis were enrolled in this study. Coronal flexibility and rotation correction were compared on the supine bending, traction and fulcrum bending radiographs. The apical vertebral body rib ratio (AVB-R), and Perdriolle rotation angles were used to measure the rotation of the main thoracic curve. Statistical analysis was performed with one-way Analysis of Variance(ANOVA). Correlations between postoperative AVB-R and AVB-R in supine bending, traction and fulcrum bending radiographs were assessed utilizing the Linear Regression. RESULTS There were trends towards increased coronal flexibility in fulcrum bending versus traction versus supine bending, but there were no significant differences due to the limited sample size. And all were significantly lower than postoperative correction. The correction of AVB-R at traction and supine bending radiographs were significantly better than fulcrum bending, however, all were significantly lower than postoperative correction. Correction of Perdriolle rotation angle at traction radiograph was best among these methods. A univariant linear regression analysis showed a strong linear correlation between the postoperative AVB-R and the AVB-R in the traction radiograph. CONCLUSIONS As to patients with severe AIS, the coronal plane flexibility evaluated at the fulcrum bending radiograph is superior to that at the traction radiograph. This may be explained by the measurement errors induced by the better derotation capacity at the traction radiograph. Rotation correction evaluated at the traction radiograph proves better than the fulcrum bending radiographs, showing a linear correlation with the postoperative correction.
在评估青少年特发性脊柱侧凸（AIS）患者时，仅使用柔韧性评估方法来评估冠状 Cobb 角的变化。在这些方法中，很少关注椎体旋转。
本研究纳入了 21 例严重青少年特发性脊柱侧凸患者。比较了仰卧位弯曲、牵引和支点弯曲 X 线片中的冠状柔韧性和旋转矫正。使用顶椎椎体肋骨比（AVB-R）和 Perdriolle 旋转角来测量主胸弯的旋转。采用单因素方差分析（ANOVA）进行统计学分析。利用线性回归评估术后 AVB-R 与仰卧位弯曲、牵引和支点弯曲 X 线片中 AVB-R 的相关性。
由于样本量有限，支点弯曲与牵引相比，冠状柔韧性有增加的趋势，但无统计学差异。并且，与术后矫正相比，所有的柔韧性均明显降低。牵引和仰卧位弯曲 X 线片中的 AVB-R 矫正均显著优于支点弯曲，但与术后矫正相比，所有的矫正均明显降低。在这些方法中，牵引 X 线片中的 Perdriolle 旋转角度矫正最佳。单变量线性回归分析显示，术后 AVB-R 与牵引 X 线片中的 AVB-R 之间存在很强的线性相关性。
对于严重 AIS 患者，在支点弯曲 X 线片中评估的冠状面柔韧性优于牵引 X 线片。这可能是由于牵引 X 线片中更好的去旋转能力引起的测量误差所致。在牵引 X 线片中评估的旋转矫正比支点弯曲 X 线片更好，与术后矫正呈线性相关。
