Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France.
Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
J Bone Joint Surg Am. 2023 May 3;105(9):676-686. doi: 10.2106/JBJS.22.00977. Epub 2023 Mar 22.
In the past decades, it has been recognized that sagittal alignment of the spine is crucial. Although the evolution of spinal alignment with growth has previously been described, there are no data for key parameters such as the exact shapes (extent and magnitude) of spinal curvatures. The goals of this study were therefore to determine normative values of spinopelvic sagittal parameters and to explore their variation during growth, based on the analysis of a large national cohort of healthy children.
The radiographic data of 1,059 healthy children were analyzed in a retrospective, multicenter study. Full spine radiographs were used to measure several sagittal parameters, such as pelvic parameters, T1-T12 thoracic kyphosis (TK), and L1-S1 lumbar lordosis (LL). TK was divided into proximal, middle, and distal parts, and LL was divided into proximal and distal parts. Patients were stratified into 5 groups according to skeletal maturity (based on age, Risser stage, and triradiate cartilage status).
During growth, pelvic incidence increased from 40° to 46° and pelvic tilt increased from 4° to 9° (p < 0.05), whereas sacral slope remained constant. The peak of change in pelvic parameters occurred at the beginning of pubertal growth in Group 2 (the first part of the pubertal growth spurt). TK slightly increased among groups from 39° to 41° (p = 0.005), with the peak of change occurring in Group 4 (pubertal growth deceleration). LL increased from 51° to 56° (p < 0.001), with the peak of change occurring in Group 3 (the second part of the pubertal growth spurt). Segmental analysis revealed that most of the TK and LL changes occurred in the distal TK and proximal LL, with the other parts remaining constant.
This is one of the largest studies showing changes in sagittal alignment with growth in normal children and adolescents. We found that changes in spinal shape were cascading phenomena. At the beginning of the growth peak, pelvic incidence increased. This change in pelvic morphology led to an increase in LL, involving its proximal part. Finally, TK increased, in its distal part, at the end of pubertal growth.
Prognostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
在过去的几十年中，人们已经认识到脊柱矢状位的排列至关重要。尽管脊柱的生长发育已经有了相关的演变描述，但对于关键参数（如脊柱弯曲的确切形状[程度和幅度]），目前还没有数据。因此，本研究的目的是确定正常儿童脊柱骨盆矢状参数的正常值，并基于对大量健康儿童的全国性队列分析，探讨其在生长过程中的变化。
本回顾性多中心研究分析了 1059 名健康儿童的影像学资料。采用全脊柱 X 线片测量了多个矢状参数，如骨盆参数、T1-T12 胸段后凸（thoracic kyphosis，TK）和 L1-S1 腰椎前凸（lordosis，LL）。TK 分为近端、中段和远端三部分，LL 分为近端和远端两部分。根据年龄、Risser 分期和三射线软骨状态，患者被分为 5 组骨骼成熟度。
在生长过程中，骨盆入射角从 40°增加到 46°，骨盆倾斜度从 4°增加到 9°（p<0.05），而骶骨倾斜度保持不变。骨盆参数的变化峰值出现在第 2 组（青春期生长突增的第一阶段）青春期生长开始时。各组间 TK 从 39°增加到 41°（p=0.005），变化峰值出现在第 4 组（青春期生长减速期）。LL 从 51°增加到 56°（p<0.001），变化峰值出现在第 3 组（青春期生长突增的第二阶段）。节段性分析显示，大部分 TK 和 LL 的变化发生在远端 TK 和近端 LL，而其他部位保持不变。
这是研究正常儿童和青少年矢状位排列随生长发育变化的最大研究之一。我们发现，脊柱形态的变化是级联现象。在生长高峰开始时，骨盆入射角增加。这种骨盆形态的变化导致 LL 增加，涉及近端部分。最后，在青春期生长结束时，远端 TK 增加。
预后 IV 级。请参阅作者指南，以获取完整的证据水平描述。
