Fan Yunli, To Michael Kai-Tsun, Yeung Eric Hiu Kwong, Kuang Guan-Ming, Liang Ruixin, Cheung Jason Pui Yin
Department of Physiotherapy, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
Department of Orthopaedics & Traumatology, The University of Hong Kong, Hong Kong SAR, China.
Asian Spine J. 2023 Oct;17(5):922-932. doi: 10.31616/asj.2023.0199. Epub 2023 Sep 11.
This study adopted a prospective cohort study design.
This study aimed to examine electromyogram (EMG) discrepancy in paravertebral muscle activity and scoliosis progression, determine how vertebral morphology and EMG discrepancy evolve during scoliosis progression, and identify differences in EMG activity between individuals with and without adolescent idiopathic scoliosis (AIS).
Higher EMG activity is observed in the convex side of scoliotic curves, but not in populations without scoliosis, suggesting that higher EMG activity is a causative factor for curve progression.
In this study, 267 matched pairs of AIS and controls were recruited. The participants underwent EMG measurements at their first presentation and did not receive any treatment for 6 months at which point they underwent EMG and radiographs. Early curve progression was defined as >5° in Cobb angle at 6 months. The root mean square of the EMG (rms-EMG) signal was recorded with the participants in sitting and back extension. The rms-EMG ratio at the upper end vertebrae, apical vertebrae (AV), and lower end vertebrae (LEV) of the major curve was calculated.
The rms-EMG ratio in the scoliosis cohort was high compared with that in the controls (sitting: 1.2±0.3 vs. 1.0±0.1, p<0.01; back extension: 1.1±0.2 vs. 1.0±0.1, p<0.01). An AV rms-EMG ratio in back extension, with a cutoff threshold of ≥1.5 in the major thoracic curve and ≥1.3 in the major lumbar curve, was a risk factor for early curve progression after 6 months without treatment (odds ratio, 4.1; 95% confidence interval, 2.8-5.9; p<0.01). Increases in side deviation (SD) (distance between the AV and the central sacral line) were related to a higher rms-EMG ratio in LEV of the major thoracic curve (baseline: rs=0.2, p=0.03; 6 months: rs=0.3, p<0.01).
An EMG discrepancy was detected in the scoliosis cohort, which was related to increases in SD in the major thoracic curve. The AV rms-EMG ratio in back extension was correlated with curve progression after 6 months of no treatment.
本研究采用前瞻性队列研究设计。
本研究旨在检查椎旁肌活动中的肌电图（EMG）差异与脊柱侧弯进展情况，确定在脊柱侧弯进展过程中椎体形态和EMG差异如何演变，并识别青少年特发性脊柱侧弯（AIS）患者与非患者之间的EMG活动差异。
在脊柱侧弯曲线的凸侧观察到较高的EMG活动，但在无脊柱侧弯的人群中未观察到，这表明较高的EMG活动是曲线进展的一个致病因素。
在本研究中，招募了267对匹配的AIS患者和对照。参与者在首次就诊时接受EMG测量，并且在6个月内未接受任何治疗，此时他们再次接受EMG测量和X光检查。早期曲线进展定义为6个月时Cobb角增加>5°。在参与者坐着和后伸时记录EMG的均方根（rms-EMG）信号。计算主曲线上端椎、顶椎（AV）和下端椎（LEV）处的rms-EMG比值。
与对照组相比，脊柱侧弯队列中的rms-EMG比值较高（坐姿：1.2±0.3对1.0±0.1，p<0.01；后伸：1.1±0.2对1.0±0.1，p<0.01）。在不进行治疗6个月后，后伸时AV的rms-EMG比值，以主胸弯≥1.5、主腰弯≥1.3为截断阈值，是早期曲线进展的危险因素（比值比，4.1；95%置信区间，2.8 - 5.9；p<0.01）。主胸弯LEV处的侧方偏移（SD）（AV与骶骨中线之间的距离）增加与较高的rms-EMG比值相关（基线：rs = 0.2，p = 0.03；6个月：rs = 0.3，p<0.01）。
在脊柱侧弯队列中检测到EMG差异，这与主胸弯中SD的增加有关。后伸时AV的rms-EMG比值与未治疗6个月后的曲线进展相关。
