Li Zhikun, Li Gengwu, Chen Chao, Li Yifan, Yang Changwei, Li Ming, Xu Wei, Zhu Xiaodong
Department of Orthopedics, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Department of Orthopedics, Panzhihua Central Hospital, Panzhihua, Sichuan Province Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Medicine (Baltimore). 2017 Dec;96(52):e9425. doi: 10.1097/MD.0000000000009425.
Various parameters related to growth and maturity have been shown to be risk factors for scoliosis curve progression. We previously identified correlations between curve progression and radiographic parameters in clinical practice, but there is a lack of research.The aim of this study was to investigate and identify the radiographic parameters that are risk factors for rapid curve progression in Lenke 5 or 6 adolescent idiopathic scoliosis (AIS).A retrospective review of patients who were prospectively enrolled at the initiation of brace wear and followed through completion of bracing or surgery was performed. The inclusion criteria were as follows: a Lenke type 5 or 6 classification, Risser sign grade 0 or 1 at the initial outpatient examination, a follow-up period of 6 months including a minimum of 4 follow-ups, At each visit, the whole spine x-ray was completed, the following data were measured and collected: angle of the lumbar curve (LC), rotation of the apical vertebra (RAV) in the LC, deviation of the apical vertebra (DAV) in the lumbar curve, clavicle angle, L5 tilt angle (TA), body mass index, flexibility of the LC (FLC), and peak angle velocity (PAV). A binary logistic regression analysis was used to assess the contribution of each variable to PAV onset. The touch types for the determination of the lowest instrumented vertebra (LIV) were compared at both the PAV and final follow-up.Thirty-six AIS patients were recruited. The binary logistic regression model indicated that the following variable values significantly contributed to a high risk of PAV occurrence: LC ≥30° (OR = 6.153, 95%CI = 1.683-22.488, P = .006), RAV ≥III (OR = 15.484, 95%CI = 4.535-52.865, P <.001), DAV ≥40 mm (OR = 8.599, 95%CI = 2.483-29.784, P <.001), and TA ≥10° (OR = 2.223, 95%CI = 3.094-27.563, P <.001). The touch types for LIV determination changed in 12 of 36 patients, with at least 1 segment added as the LIV between the PAV and the final visit.LC ≥30°, RAV ≥III, DAV ≥40 mm, and L5 TA≥10° were radiographic parameters associated with an increased risk of curve progression in Lenke 5 and 6 AIS. The orthopedic surgery performed at the PAV is the ideal timing, and it will preserve 1 active segment than later surgery.Level of evidence was 4.
多种与生长和成熟相关的参数已被证明是脊柱侧弯曲线进展的危险因素。我们之前在临床实践中确定了曲线进展与影像学参数之间的相关性，但缺乏相关研究。本研究的目的是调查并确定在Lenke 5或6型青少年特发性脊柱侧弯（AIS）中快速曲线进展的危险因素的影像学参数。对前瞻性纳入的患者进行回顾性研究，这些患者在开始佩戴支具时入组，并随访至支具治疗结束或手术完成。纳入标准如下：Lenke 5或6型分类，初次门诊检查时Risser征为0级或1级，随访期为6个月，包括至少4次随访。每次就诊时，均完成全脊柱X光检查，测量并收集以下数据：腰椎曲线角度（LC）、腰椎曲线顶椎旋转度（RAV）、腰椎曲线顶椎偏移度（DAV）、锁骨角度、L5倾斜角（TA）、体重指数、腰椎曲线柔韧性（FLC）和峰值角度速度（PAV）。采用二元逻辑回归分析评估每个变量对PAV发生的贡献。在PAV和最终随访时比较确定最低融合椎（LIV）的触摸类型。共招募了36例AIS患者。二元逻辑回归模型表明，以下变量值显著增加了PAV发生的高风险：LC≥30°（OR = 6.153，95%CI = 1.683 - 22.488，P = 0.006），RAV≥III级（OR = 15.484，95%CI = 4.535 - 52.865，P < 0.001），DAV≥40 mm（OR = 8.599，95%CI = 2.483 - 29.784，P < 0.001），以及TA≥10°（OR = 2.223，95%CI = 3.094 - 27.563，P < 0.001）。36例患者中有12例LIV确定的触摸类型发生了变化，在PAV和最终随访之间至少增加了1个节段作为LIV。LC≥30°、RAV≥III级、DAV≥40 mm和L5 TA≥10°是与Lenke 5和6型AIS曲线进展风险增加相关的影像学参数。在PAV时进行骨科手术是理想时机，与后期手术相比，可保留1个活动节段。证据等级为4级。
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