Marshall Orthopaedic Surgery Resident, 1600 Medical Center Drive, Suite G500, Huntington, WV, 25701, USA.
Shriners Hospitals for Children Medical Center, University of Kentucky, 110 Conn Terrace Lexington, Lexington, KY, 40508, USA.
Spine Deform. 2021 Jul;9(4):1049-1052. doi: 10.1007/s43390-020-00271-6. Epub 2021 Jan 13.
Retrospective chart and radiographic review.
The purpose of this study is to determine if both traction and side-bending radiographs yield the same Lenke classification. Supine side-bending radiographs are used to evaluate curve flexibility and assign Lenke classification in Adolescent Idiopathic Scoliosis (AIS). Supine traction radiographs are another tool used by treating surgeons to gauge flexibility and appropriate levels for spinal fusion in AIS.
Retrospective chart and radiographic review were performed on AIS patients that underwent a posterior spinal fusion from 2008 to 2017. Cobb angles and Lenke classifications were determined on all upright posterioanterior (PA) spine radiographs, supine traction radiographs, and four supine bending radiographs. Statistical analysis using independent t tests and chi-square tests as appropriate were compared between patients with or without discordant Lenke classifications with p value set at < 0.05 for statistical significance.
184 patients met inclusion criteria, 36 males and 148 females. The average Cobb angle for the proximal thoracic (PT) curve was 27.2°, main thoracic (MT) curve was 60.5°, and thoracolumbar/lumbar (TL/L) curve was 48.0°. Significantly less curve correction was found with supine traction radiographs compared with bending radiographs: PT (23.1° vs 18.9°, p < 0.001), MT (38.9° vs 37.9°, p = 0.015), and TL/L (25.9° vs. 18.0°, p < 0.001). Lenke Classification was found concordant in 151/184 (82.1%). Traction views in the discordant Lenke classification group demonstrated less curve correction than those in the concordant group: PT (27.4° vs. 22.1°, p = 0.011), MT (45.3° vs. 37.5°, p < 0.001), and TL/L (29.3° vs 25.1°, p = 0.019).
Supine traction and supine bending radiographs provided a concordant Lenke classification 82.1% of the time. However, supine traction radiographs demonstrate less curve correction, a higher Lenke classification, and underestimated the TL/L curve correction to a greater degree. A single supine traction film is not an adequate substitute to side-bending radiographs when determining Lenke classification in patients with Adolescent Idiopathic Scoliosis.
III.
回顾性图表和射线照相复查。
本研究的目的是确定牵引和侧屈射线照相是否都能产生相同的 Lenke 分类。仰卧位侧屈射线照相用于评估曲线灵活性并在青少年特发性脊柱侧凸（AIS）中分配 Lenke 分类。仰卧位牵引射线照相是治疗外科医生用于评估灵活性和确定 AIS 脊柱融合适当水平的另一种工具。
对 2008 年至 2017 年间接受后路脊柱融合术的 AIS 患者进行回顾性图表和射线照相复查。所有直立前后位（PA）脊柱射线照相、仰卧位牵引射线照相和 4 个仰卧位弯曲射线照相上确定 Cobb 角和 Lenke 分类。使用独立 t 检验和适当的卡方检验进行统计学分析，比较具有或不具有不一致 Lenke 分类的患者之间的差异，p 值设为<0.05 表示统计学意义。
184 名符合纳入标准的患者，其中 36 名男性和 148 名女性。近端胸（PT）曲线的平均 Cobb 角为 27.2°，主胸（MT）曲线为 60.5°，胸腰/腰椎（TL/L）曲线为 48.0°。与弯曲射线照相相比，仰卧位牵引射线照相的曲线矫正明显减少：PT（23.1°比 18.9°，p<0.001）、MT（38.9°比 37.9°，p=0.015）和 TL/L（25.9°比 18.0°，p<0.001）。在 184 名患者中，151 名（82.1%）的 Lenke 分类一致。在不一致的 Lenke 分类组中，牵引视图的曲线矫正比一致组少：PT（27.4°比 22.1°，p=0.011）、MT（45.3°比 37.5°，p<0.001）和 TL/L（29.3°比 25.1°，p=0.019）。
仰卧位牵引和仰卧位弯曲射线照相的 Lenke 分类一致的比例为 82.1%。然而，仰卧位牵引射线照相显示曲线矫正较少，Lenke 分类较高，并且对 TL/L 曲线矫正的低估程度更大。在确定青少年特发性脊柱侧凸患者的 Lenke 分类时，单次仰卧位牵引片不能替代侧屈射线照相。
III 级。
