Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany.
Skoliosechirurgie, Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, SRH Klinikum Karlsbad-Langensteinbach gGmbH, Karlsbad, Germany.
J Anat. 2022 Jan;240(1):120-130. doi: 10.1111/joa.13528. Epub 2021 Aug 3.
The morphology of the rib cage affects both the biomechanics of the upper body's musculoskeletal structure and the respiratory mechanics. This becomes particularly important when evaluating skeletal deformities, as in adolescent idiopathic scoliosis (AIS). The aim of this study was to identify morphological characteristics of the rib cage in relation to the lung in patients with non-deformed and scoliotic spines. Computed tomography data of 40 patients without any visible spinal abnormalities (healthy group) and 21 patients with AIS were obtained retrospectively. All bony structures as well as the right and left lung were reconstructed using image segmentation. Morphological parameters were calculated based on the distances between characteristic morphological landmarks. These parameters included the rib position, length, and area, the rib cage depth and width, and the rib inclination angle on either side, as well as the spinal height and length. Furthermore, we determined the left and right lung volumes, and the area of contact between the rib cage and lung. Differences between healthy and scoliotic spines were statistically analysed using the t-test for unpaired data. The rib cage of the AIS group was significantly deformed in the dorso-ventral and medio-lateral directions. The anatomical proximity of the lung to the ribs was nearly symmetrical in the healthy group. By contrast, within the AIS group, the lung covered a significantly greater area on the left side of the rib cage at large thoracic deformities. Within the levels T1-T6, no significant difference in the rib length, depth to width relationship, or area was observed between the healthy and AIS groups. Inferior to the lung (T7-T12), these parameters exhibited greater variability. The ratio between the width of the rib cage at T6 and the thoracic spinal height (T1-T12) was significantly increased within the thoracic AIS group (1.1 ± 0.08) compared with the healthy group (1.0 ± 0.05). No statistical differences were found between the lung volumes among all the groups. While the rib cage was frequently strongly deformed in the AIS group, the lung and its surrounding ribs appeared to be normally developed. The observed rib hump in AIS appeared to be formed particularly by a more ventral position of the ribs on the concave side. Furthermore, the rib cage width to spinal height ratio suggested that the spinal height of the thoracic AIS-spine is reduced. This indicates that the spine would gain its growth-related height after correcting the spinal deformity. These are the important aspects to consider in the aetiology research and orthopaedic treatment of AIS.
胸廓形态不仅影响上半身肌肉骨骼结构的生物力学，还影响呼吸力学。在评估骨骼畸形时，这一点尤为重要，如青少年特发性脊柱侧凸 (AIS)。本研究旨在确定非畸形和脊柱侧凸患者的胸廓形态与肺部之间的关系。回顾性地获得了 40 名无明显脊柱异常（健康组）和 21 名 AIS 患者的计算机断层扫描数据。使用图像分割对所有骨骼结构以及右肺和左肺进行重建。基于特征形态标志之间的距离计算形态学参数。这些参数包括肋骨位置、长度和面积、胸廓深度和宽度、两侧肋骨倾斜角，以及脊柱高度和长度。此外，我们还确定了左肺和右肺的体积，以及胸廓和肺之间的接触面积。使用配对数据的 t 检验对健康和脊柱侧凸脊柱之间的差异进行统计学分析。AIS 组的胸廓在背腹和内外方向上均发生明显变形。健康组的肺部与肋骨的解剖接近度几乎是对称的。相比之下，在 AIS 组中，在较大的胸廓畸形时，左侧胸廓覆盖的肺部面积明显更大。在 T1-T6 水平，健康组和 AIS 组之间的肋骨长度、深度与宽度的关系或面积没有显著差异。在肺以下（T7-T12），这些参数的变化较大。在 AIS 组的 T6 胸廓宽度与 T1-T12 胸椎高度的比值（1.1±0.08）显著高于健康组（1.0±0.05）。各组之间的肺体积没有统计学差异。尽管 AIS 组的胸廓经常发生强烈变形，但肺部及其周围肋骨似乎发育正常。在 AIS 中观察到的肋骨隆起似乎是由凹侧肋骨的更腹侧位置形成的。此外，胸廓宽度与脊柱高度的比值表明，AIS 脊柱的胸椎高度降低。这表明在纠正脊柱畸形后，脊柱将获得与其生长相关的高度。这些是青少年特发性脊柱侧凸病因研究和矫形治疗中需要考虑的重要方面。
