Department of Orthopedic Surgery, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea.
Spine (Phila Pa 1976). 2019 Dec 1;44(23):E1362-E1368. doi: 10.1097/BRS.0000000000003168.
A retrospective cohort, radiographic study.
The aim of this study was to compare the progression of scoliosis owing to single hemivertebra (HV) during early childhood, according to the anteroposterior discordance obtained from the three-dimensional computed tomography (3D-CT) studies.
Previous studies have utilized 3D-CT for the classification of congenital spinal deformities and have introduced the concept of two types of deformity: unison and discordant anomalies. However, there have been no further studies on the clinical significance of these discordant deformities, especially in the identification of deformities that will progress and require an operation.
We retrospectively analyzed 97 cases of single HV with thoracolumbar scoliosis, diagnosed in children before the age of 3 years and followed up past the age of 6 years. The segmentation of the anterior and posterior components, and anteroposterior discordance of the HV were evaluated using 3D-CT images. Coronal segmental curve angle (SCA) and balance were measured using whole spine plain radiographs.
Using 3D-CT, 41 (42.3%) cases of unison HV and 56 (57.7%) discordant HV were identified. Unison HV comprised 21 (21.6%) cases of fully segmented (FS) unison HV and 20 (20.6%) cases of semi-segmented unison HV with corresponding anterior and posterior segmentation. Fifty-six cases of discordant HV were further classified into 4 different types. In the 86 patients who were followed without operation between the ages of 3 and 6 years, the average progression of SCA was significantly larger in FS unison HV (one-way analysis of variance, P < 0.001). Ten of 86 (11.6%) patients showed a coronal imbalance at the age of 6 years, but the proportion of patients with coronal imbalance was not significantly different among the deformity types.
Anteroposterior discordance on 3D analysis is a useful indicator for the progression of congenital scoliosis due to single HV in early childhood.
回顾性队列，影像学研究。
本研究旨在通过三维 CT（3D-CT）研究获得的前后不匹配，比较因单节段半椎体（HV）引起的早期儿童脊柱侧凸的进展情况。
先前的研究已经使用 3D-CT 对先天性脊柱畸形进行分类，并提出了两种畸形类型的概念：一致和不一致异常。然而，对于这些不一致的畸形的临床意义，特别是在识别需要手术治疗的进展性畸形方面，尚无进一步的研究。
我们回顾性分析了 97 例胸椎腰椎侧凸的单节段 HV 病例，这些病例均在 3 岁以下儿童中诊断，并在 6 岁后进行随访。使用 3D-CT 图像评估 HV 的前、后部分的分割和前后不匹配。使用全脊柱平片测量冠状节段曲线角度（SCA）和平衡。
使用 3D-CT，我们发现 41 例（42.3%）为一致 HV，56 例（57.7%）为不一致 HV。一致 HV 包括 21 例（21.6%）完全分割（FS）一致 HV 和 20 例（20.6%）具有相应前后分割的半分割一致 HV。56 例不一致 HV 进一步分为 4 种不同类型。在 86 例未接受手术治疗的患者中，3 至 6 岁期间 SCA 的平均进展在 FS 一致 HV 中明显更大（单因素方差分析，P<0.001）。86 例患者中有 10 例（11.6%）在 6 岁时出现冠状面失衡，但不同畸形类型之间的冠状面失衡患者比例无显著差异。
3D 分析中的前后不匹配是早期儿童因单节段半椎体引起的先天性脊柱侧凸进展的有用指标。
4 级。
