Clement R Carter, Anari Jason, Bartley Carrie E, Bastrom Tracey P, Shah Ronit, Talwar Divya, Upasani Vidyadhar V
Department of Pediatric Orthopedic Surgery, Children's Hospital of New Orleans, New Orleans, LA, USA.
Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Spine Deform. 2020 Aug;8(4):621-627. doi: 10.1007/s43390-020-00074-9. Epub 2020 Feb 24.
Retrospective.
To define normal values and distributions for sagittal, coronal, and shoulder balance among healthy adolescents, both for traditional radiographs and biplanar radiography. Our understanding of spine balance, especially in the sagittal plane, has expanded rapidly in recent years. Additionally, there has been growing use of simultaneous biplanar radiography which requires slightly different patient positioning. However, the normal ranges of several commonly used parameters have not yet been defined, either in traditional or biplanar radiography.
Radiographs were retrospectively reviewed of 273 patients aged 10-18 years seen in spine clinics at two high-volume centers and not diagnosed with any spine pathology. One center utilized traditional radiography and the other biplanar radiography. Coronal, sagittal, and shoulder balance were measured for each patient. Intra-observer reliability and normal values with distributions were reported for each parameter.
Intra-observer reliability was excellent (intra-class correlation coefficients ≥ 0.98). Each parameter was normally distributed at each institution based on Kolmogorov-Smirnov testing. Sagittal balance was more negative at the institution using traditional radiographs (- 3.4 ± 4.2 vs. 0.3 ± 2.2, p < 0.001). Coronal balance was statistically, but not clinically, significantly more negative at this institution (- 0.6 ± 1.4 vs. - 0.2 ± 1.0, p = 0.007). Shoulder balance was not different between institutions. The "normal" ranges (mean ± 2 standard deviations, i.e., expected to include 95% of patients) were - 2.8 to 2.0 cm for coronal balance, - 9.0 to 6.1 cm for sagittal balance, and - 1.5-2.4 cm for shoulder balance.
In adolescents without known spine pathology, the mean coronal, sagittal, and shoulder balance is near neutral, but each parameter varies over a large range; so the average patient deviates from neutral by 1.0 ± 0.7 cm, 3.1 ± 2.6 cm, and 0.9 ± 0.7 cm, respectively. The most important difference between biplanar and traditional radiographs was a significantly more negative sagittal balance in the biplanar group which may be attributable to arm positioning.
Level III.
回顾性研究。
确定健康青少年矢状面、冠状面和肩部平衡的正常值及分布情况，涵盖传统X线片和双平面X线摄影。近年来，我们对脊柱平衡的理解，尤其是矢状面的理解迅速扩展。此外，双平面同步X线摄影的使用越来越多，这需要稍微不同的患者体位。然而，无论是传统X线摄影还是双平面X线摄影，一些常用参数的正常范围尚未确定。
回顾性分析了在两个大型中心脊柱门诊就诊的273例10 - 18岁患者的X线片，这些患者未被诊断出任何脊柱病变。一个中心采用传统X线摄影，另一个中心采用双平面X线摄影。测量了每位患者的冠状面、矢状面和肩部平衡。报告了每个参数的观察者内可靠性以及带有分布情况的正常值。
观察者内可靠性极佳（组内相关系数≥0.98）。根据柯尔莫哥洛夫 - 斯米尔诺夫检验（Kolmogorov-Smirnov testing），每个机构的每个参数均呈正态分布。使用传统X线片的机构矢状面平衡更偏向负值（-3.4±4.2 vs. 0.3±2.2，p<0.001）。该机构的冠状面平衡在统计学上更偏向负值，但在临床上无显著差异（-0.
