青少年特发性脊柱侧凸中胸椎与腰椎主弯的三维矢状面轮廓

The 3D Sagittal Profile of Thoracic Versus Lumbar Major Curves in Adolescent Idiopathic Scoliosis.

作者信息

Newton Peter O, Osborn Emily J, Bastrom Tracey P, Doan Joshua D, Reighard Fredrick G

机构信息

Department of Orthopedics, Rady Children's Hospital, 3020 Children's Way, San Diego, CA 92123, USA; Department of Orthopaedics, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0021, USA.

Department of Orthopaedics, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0021, USA.

出版信息

Spine Deform. 2019 Jan;7(1):60-65. doi: 10.1016/j.jspd.2018.05.003.

DOI:10.1016/j.jspd.2018.05.003

PMID:30587322

Abstract

STUDY DESIGN

Retrospective.

OBJECTIVE

To compare the 3D sagittal profile of patients with main thoracic or thoracolumbar/lumbar adolescent idiopathic scoliosis (AIS) to a normal cohort.

SUMMARY OF BACKGROUND INFORMATION

Thoracic AIS is often associated with a loss of kyphosis. Classically, this measure has been made in 2D, which may underestimate the true sagittal deformity.

METHODS

Biplanar upright radiographs were obtained on 152 primary thoracic (TH: Lenke 1-4), 50 primary thoracolumbar/lumbar (TL/L: Lenke 5-6) curves, and 89 normal controls (NC). 3D spinal reconstructions were created using sterEOS software. MATLAB code was used to create segmental measurements of kyphosis/lordosis for each vertebral and disc segment from T1 to S1 in the local coordinate system of each motion segment. Comparisons were made between groups for the 3D summed segmental measures (T1-T5, T5-T12, T12-S1), pelvic incidence, sacral slope, and pelvic tilt.

RESULTS

Mean 2D Cobb was 57°±12° (range 40°-115°) for TH curves and 52°±9° (range 37°-75°) for TL/L curves. Significant differences in 3D sagittal measures were found between the 3 groups. Post hoc tests revealed significant differences at T1-T5, TH<NC, and TL/L<NC. All groups differed from each other from T5-T12, with the least kyphosis in TH curves. T12-S1 lordosis was significantly greater in TH and TL/L curves compared with NC. Lumbar lordosis extended proximally an average of one segment in AIS compared to normal spines (T11 vs T12). Pelvic incidence, sacral slope, and pelvic tilt were significantly greater for TH curves compared to NC.

CONCLUSIONS

There is a substantial average loss of thoracic kyphosis (∼15°-25°) for both primary thoracic and primary thoracolumbar/lumbar AIS curves compared to normal adolescents. Three-dimensional assessment of scoliosis allows the "true" deformity to be measured by correcting for error due to out-of-plane measurement associated with conventional 2D measurements.

LEVEL OF EVIDENCE

Level II, prognostic.

摘要

研究设计

回顾性研究。

目的

比较主要为胸段或胸腰段/腰段青少年特发性脊柱侧凸（AIS）患者与正常人群的三维矢状面轮廓。

背景信息总结

胸段AIS常伴有后凸丢失。传统上，这一测量是在二维平面上进行的，可能会低估真正的矢状面畸形。

方法

对152例主要为胸段（TH：Lenke 1 - 4型）、50例主要为胸腰段/腰段（TL/L：Lenke 5 - 6型）的脊柱侧弯患者以及89例正常对照者（NC）拍摄双平面站立位X线片。使用sterEOS软件进行三维脊柱重建。利用MATLAB代码在每个运动节段的局部坐标系中对T1至S1的每个椎体和椎间盘节段的后凸/前凸进行节段测量。对三组之间的三维节段测量总和（T1 - T5、T5 - T12、T12 - S1）、骨盆入射角、骶骨倾斜度和骨盆倾斜度进行比较。

结果

胸段曲线的平均二维Cobb角为57°±12°（范围40° - 115°），胸腰段/腰段曲线为52°±9°（范围37° - 75°）。三组之间在三维矢状面测量上存在显著差异。事后检验显示在T1 - T5节段存在显著差异，胸段组（TH）<正常对照组（NC），胸腰段/腰段组（TL/L）<正常对照组（NC）。在T5 - T12节段，所有组之间均存在差异，胸段曲线的后凸最小。与正常对照组相比，胸段和胸腰段/腰段曲线的T12 - S1前凸显著更大。与正常脊柱相比，AIS患者的腰椎前凸平均向上延伸一个节段（T11对比T12）。与正常对照组相比，胸段曲线的骨盆入射角、骶骨倾斜度和骨盆倾斜度显著更大。