Chan Chris Yin Wei, Naing Kyaw Soe, Chiu Chee Kidd, Mohamad Siti Mariam, Kwan Mun Keong
1 Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
2 Institute of Medicine (1), Yangon Orthopaedic Hospital (Spine Unit), Yangon General Hospital (Trauma unit), Yangon, Myanmar.
J Orthop Surg (Hong Kong). 2019 May-Aug;27(2):2309499019857250. doi: 10.1177/2309499019857250.
To analyze the incidence, pattern, and contributing factors of pelvic obliquity among Adolescent Idiopathic Scoliosis (AIS) patients who will undergo surgery.
In total, 311 patients underwent erect whole spine anteroposterior, lateral and lower limb axis films. Radiographic measurements included Transilium Pelvic Height Difference (TPHD; mm), Hip Abduction-Adduction angle (H/Abd-Add; °), Lower limb Length Discrepancy (LLD; mm), and Pelvic Hypoplasia (PH angle; °). The incidence and severity of pelvic obliquity were stratified to Lenke curve subtypes in 311 patients. The causes of pelvic obliquity were analyzed in 57 patients with TPHD ≥10 mm.
The mean Cobb angle was 64.0 ± 17.2°. Sixty-nine patients had a TPHD of 0 mm (22.2%). The TPHD was <5 mm in 134 (43.0%) patients, 5-9 mm in 104 (33.4%) patients, 10-14 mm in 52 (16.7%) patients, 15-19 mm in 19 (6.1%) patients, and ≥20 mm in only 2 (0.6%) patients. There was a significant difference between the Lenke curve types in terms of TPHD ( = 0.002). L6 curve types had the highest TPHD of 9.0 ± 6.3 mm followed by L5 curves, which had a TPHD of 7.1 ± 4.8 mm. In all, 44.2% of L1 curves and 50.0% of L2 curves had positive TPHD compared to 66.7% of L5 curves and 74.1% of L6 curves which had negative TPHD. 33.3% and 24.6% of pelvic obliquity were attributed to PH and LLD, respectively, whereas 10.5% of cases were attributed to H/Abd-Add positioning.
76.4% of AIS cases had pelvic obliquity <10 mm; 44.2% of L1 curves and 50.0% of L2 curves had a lower right hemipelvis compared to 66.7% of L5 curves and 74.1% of L6 curves, which had a higher right hemipelvis. Among patients with pelvic obliquity ≥10 mm, 33.3% were attributed to PH, whereas 24.6% were attributed to LLD.
分析拟接受手术的青少年特发性脊柱侧凸（AIS）患者骨盆倾斜的发生率、模式及相关因素。
共311例患者拍摄了站立位全脊柱前后位、侧位及下肢轴线片。影像学测量包括经髂骨盆高度差（TPHD；mm）、髋关节外展-内收角（H/Abd-Add；°）、下肢长度差异（LLD；mm）以及骨盆发育不全（PH角；°）。对311例患者骨盆倾斜的发生率及严重程度按Lenke曲线亚型进行分层。对TPHD≥10 mm的57例患者分析骨盆倾斜的原因。
平均Cobb角为64.0±17.2°。69例患者TPHD为0 mm（22.2%）。134例（43.0%）患者TPHD＜5 mm，104例（33.4%）患者TPHD为5 - 9 mm，52例（16.7%）患者TPHD为10 - 14 mm，19例（6.1%）患者TPHD为15 - 19 mm，仅2例（0.6%）患者TPHD≥20 mm。不同Lenke曲线类型在TPHD方面存在显著差异（=0.002）。L6曲线类型的TPHD最高，为9.0±6.3 mm，其次是L5曲线，TPHD为7.1±4.8 mm。总体而言，44.2%的L1曲线和50.0%的L2曲线TPHD为正值，相比之下，66.7%的L5曲线和74.1%的L6曲线TPHD为负值。分别有33.3%和24.6%的骨盆倾斜归因于PH和LLD，而10.5%的病例归因于H/Abd-Add定位。
76.4%的AIS病例骨盆倾斜＜10 mm；44.2%的L1曲线和50.0%的L2曲线右半骨盆较低，而66.7%的L5曲线和74.1%的L6曲线右半骨盆较高。在骨盆倾斜≥10 mm的患者中，33.3%归因于PH，24.6%归因于LLD。
