Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
SH Ho Scoliosis Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
Sci Rep. 2021 Mar 18;11(1):6294. doi: 10.1038/s41598-021-85782-6.
This study aimed to characterize global sagittal alignment in adolescent idiopathic scoliosis (AIS) with normal kyphosis (NTK, kyphosis > 10°) and with thoracic hypokyphosis (THK, kyphosis < 10°), before and after posterior spinal fusion, and compare them with asymptomatic controls. 27 AIS girls and young adults with right thoracic curves were included (seventeen with age ≤ 18 years, then age > 21). Biplanar radiographies were acquired at baseline, immediate post-operatively, 1-year and 2-year follow-up, and 3D reconstruction of the spine and pelvis was performed. NTK and THK showed different global sagittal alignment, as well as differences compared to controls. AIS with THK at baseline had higher SVA/SFD (2.0 ± 2.9 vs - 0.4 ± 1.9; P < 0.05) and OD-HA (0.2 ± 1.4° vs - 1.3 ± 1.6°; P < 0.05) than controls, indicating that THK had compensated balance with unusual forward leaning posture. Immediately post-operation, SVA/SFD remained high (1.3 ± 3.0) while OD-HA reversed (- 1.2 ± 1.7°), indicating that THK patients had found partially compensated balance. After 2-yeas, both SVA/SFD (- 1.3 ± 2.1) and OD-HA (- 1.4 ± 0.9°) were normalized. The changes in global sagittal alignment and mechanism of balance are different in AIS with or without THK. As the head plays a critical role on balance during immediate and delayed post-operation, OD-HA can be complementary parameter for assessing global balance during post-operative follow-up of AIS patients with THK.
本研究旨在描述伴有正常后凸（NTK，后凸＞10°）和伴有胸椎后凸不足（THK，后凸＜10°）的青少年特发性脊柱侧凸（AIS）患者在接受后路脊柱融合前后的整体矢状面平衡特征，并将其与无症状对照者进行比较。共纳入 27 例右侧胸弯 AIS 女孩和年轻女性（17 例年龄≤18 岁，然后年龄＞21 岁）。基线、术后即刻、1 年和 2 年随访时采集双平面 X 线片，并对脊柱和骨盆进行 3D 重建。NTK 和 THK 表现出不同的整体矢状面平衡，与对照组相比也存在差异。基线时 THK 的 AIS 患者 SVA/SFD（2.0±2.9 比-0.4±1.9；P＜0.05）和 OD-HA（0.2±1.4°比-1.3±1.6°；P＜0.05）更高，表明 THK 以不寻常的前倾姿势代偿平衡。术后即刻，SVA/SFD 仍较高（1.3±3.0），而 OD-HA 逆转（-1.2±1.7°），表明 THK 患者已部分代偿平衡。2 年后，SVA/SFD（-1.3±2.1）和 OD-HA（-1.4±0.9°）均恢复正常。THK 有无的 AIS 患者的整体矢状面平衡变化和平衡机制不同。由于头部在术后即刻和延迟期对平衡起着关键作用，因此 OD-HA 可作为评估 THK 型 AIS 患者术后随访期间整体平衡的补充参数。
