Valdovino Alan G, Bastrom Tracey P, Reighard Fredrick G, Cross Madeline, Bartley Carrie E, Shah Suken A, Yaszay Burt, Newton Peter O, Upasani Vidyadhar V
University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0021, USA.
Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, 3020 Children's Way, San Diego, CA 92123, USA.
Spine Deform. 2019 Nov;7(6):865-869. doi: 10.1016/j.jspd.2019.03.010.
Retrospective comparative cohort study.
To compare radiographic parameters between adolescents with a greater body mass index (BMI) percentile to underweight individuals.
Increased BMI percentile has been associated with increased complications after surgical correction of adolescent idiopathic scoliosis (AIS). However, association between BMI percentile and preoperative sagittal plane alignment has not been evaluated. The purpose of this study was to evaluate the effect of BMI percentile on sagittal alignment in AIS patients compared with nonscoliotic adolescents.
Posterior-anterior and lateral spinal radiographs of 1,551 AIS patients with a thoracic major curve (Lenke 1-4) and 70 nonscoliotic adolescent patients were compared. BMI percentile was determined based on age and sex, and patients were divided into four categories: underweight (<5th percentile), normal-weight (5th-85th percentile), overweight (85th-95th percentile), and obese (≥95th percentile).
Coronal plane deformity magnitude was not significantly different between the 4 categories of AIS patients (p = .51). Increased BMI percentile was associated with increased thoracic kyphosis globally (T2-T12: p < .005) as well as segmentally (T2-T5: p < .001; T5-T12: p < .001) in patients with AIS. This was also true in obese adolescents without spinal deformity (p < .04). Lumbar lordosis, pelvic incidence, and pelvic tilt were not significantly different between AIS patients in the four BMI percentile categories (p > .07). Pelvic incidence was significantly greater in AIS patients compared with nonscoliotic adolescents (54 ± 13 vs. 46 ± 11; p = .01).
Increased BMI percentile is associated with increased thoracic kyphosis in AIS patients and nonscoliotic adolescents. Excess weight may reduce anterior vertebral growth. AIS patients have an increased pelvic incidence compared with nonscoliotic adolescents; however, this variable is not influenced by body mass. These relationships should be taken into account when planning sagittal plane deformity correction or considering neuro axis disorders (also associated with increased kyphosis) in patients with scoliosis.
Level II.
回顾性比较队列研究。
比较体重指数（BMI）百分位数较高的青少年与体重过轻个体之间的影像学参数。
青少年特发性脊柱侧凸（AIS）手术矫正后，BMI百分位数增加与并发症增加有关。然而，BMI百分位数与术前矢状面排列之间的关联尚未得到评估。本研究的目的是评估与非脊柱侧凸青少年相比，BMI百分位数对AIS患者矢状面排列的影响。
比较1551例患有胸段主弯（Lenke 1-4型）的AIS患者和70例非脊柱侧凸青少年患者的脊柱正侧位X线片。根据年龄和性别确定BMI百分位数，患者分为四类：体重过轻（<第5百分位数）、正常体重（第5-85百分位数）、超重（第85-95百分位数）和肥胖（≥第95百分位数）。
4类AIS患者的冠状面畸形程度无显著差异（p = 0.51）。AIS患者中，BMI百分位数增加与整体胸段后凸增加相关（T2-T12：p < 0.005），以及节段性后凸增加（T2-T5：p < 0.001；T5-T12：p < 0.001）。在无脊柱畸形的肥胖青少年中也是如此（p < 0.04）。4个BMI百分位数类别的AIS患者之间的腰椎前凸、骨盆入射角和骨盆倾斜度无显著差异（p > 0.07）。与非脊柱侧凸青少年相比，AIS患者的骨盆入射角显著更大（54±13 vs. 46±11；p = 0.01）。
BMI百分位数增加与AIS患者和非脊柱侧凸青少年的胸段后凸增加有关。超重可能会减少椎体前方生长。与非脊柱侧凸青少年相比，AIS患者的骨盆入射角增加；然而，这一变量不受体重影响。在计划矢状面畸形矫正或考虑脊柱侧凸患者的神经轴疾病（也与后凸增加有关）时，应考虑这些关系。
二级。
