Değer Göker Utku, Park Heon Jung, Park Kyeong-Hyeon, Park Hoon, Alhassan Mohammed Salman, Kim Hyun Woo, Park Kun-Bo
Department of Orthopedics and Traumatology, Beykoz State Hospital, Istanbul 34800, Türkiye.
Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul 03722, Republic of Korea.
J Clin Med. 2024 Oct 21;13(20):6289. doi: 10.3390/jcm13206289.
: The distorted vertebral body has been studied in scoliosis; however, there is little knowledge about the difference between neuromuscular and idiopathic scoliosis. This study aimed to investigate the vertebral body morphology in patients with spastic quadriplegic cerebral palsy and scoliosis (CP scoliosis) and compare them with those of apex- and Cobb angle-matched patients with adolescent idiopathic scoliosis (AIS). : Thirty-four patients with CP scoliosis and thirty-two patients with AIS were included. The pedicle diameter, chord length, and vertebral body rotation were evaluated at one level above the apex, one level below the apex, and at the apex using a reconstructed computed tomography scan. The apex of the curve and Cobb angle were too diverse between patients with CP scoliosis or AIS. Eighteen patients were matched in each group according to the apex and Cobb angle (within 5-degree differences) of the major curve, and compared between matched groups (mCPscoliosis vs. mAIS). : In the comparison of the apex and Cobb angle-matched groups, there was no statistical difference in the Cobb angle between mCPscoliosis (80.7 ± 13.8 degrees) and mAIS (78.6 ± 13.6 degrees, = 0.426), and the vertebral body rotation (25.4 ± 15.4° in mCPscoliosis vs. 24.4 ± 6.5° in mAIS, = 0.594). There was no difference in the pedicle diameters of either the convex (3.6 ± 1.1 mm in mCPscoliosis vs. 3.3 ± 1.2 mm in mAIS, = 0.24) or concave side (3.1 ± 1.2 mm in mCPscoliosis vs. 2.7 ± 1.6 mm in mAIS, = 0.127). However, the patients in the mCPscoliosis group were younger (12.7 ± 2.5 years vs. 14.6 ± 2.4 years, = 0.001), and the chord length was shorter on the convex (38.0 ± 5.0 mm vs. 40.4 ± 4.9 mm, = 0.025) and concave (37.7 ± 5.2 mm vs. 40.3 ± 4.7 mm, = 0.014) sides compared with those of the mAIS group. : With a similar apex and Cobb angle, the vertebral body rotation and pedicle diameter in patients with CP scoliosis were comparable to those with AIS; however, the chord length was shorter in CP scoliosis. For the selection of the pedicle screw in CP scoliosis, the length of the pedicle screw should be more considered than the diameter.
在脊柱侧弯研究中，已对变形的椎体进行了研究；然而，关于神经肌肉型和特发性脊柱侧弯之间的差异，人们了解甚少。本研究旨在调查痉挛性四肢瘫脑瘫合并脊柱侧弯（脑瘫性脊柱侧弯，CP脊柱侧弯）患者的椎体形态，并将其与顶椎和Cobb角匹配的青少年特发性脊柱侧弯（AIS）患者进行比较。：纳入了34例CP脊柱侧弯患者和32例AIS患者。使用重建的计算机断层扫描，在顶椎上方一个节段、顶椎下方一个节段以及顶椎处评估椎弓根直径、弦长和椎体旋转情况。CP脊柱侧弯或AIS患者之间的曲线顶点和Cobb角差异太大。根据主曲线的顶点和Cobb角（差异在5度以内）在每组中匹配18例患者，并在匹配组之间进行比较（mCP脊柱侧弯与mAIS）。：在顶点和Cobb角匹配组的比较中，mCP脊柱侧弯组（80.7±13.8度）和mAIS组（78.6±13.6度，P = 0.426）之间的Cobb角无统计学差异，椎体旋转情况也是如此（mCP脊柱侧弯组为25.4±15.4°，mAIS组为24.4±6.5°，P = 0.594）。凸侧（mCP脊柱侧弯组为3.6±1.1mm，mAIS组为3.3±1.2mm，P = 0.24）和凹侧（mCP脊柱侧弯组为3.1±1.2mm，mAIS组为2.7±1.6mm，P = 0.127）的椎弓根直径均无差异。然而，mCP脊柱侧弯组的患者更年轻（12.7±2.5岁对14.6±2.4岁，P = 0.001），与mAIS组相比，凸侧（38.0±5.0mm对40.4±4.9mm，P = 0.025）和凹侧（37.7±5.2mm对40.3±4.7mm，P = 0.014）的弦长更短。：在顶点和Cobb角相似的情况下，CP脊柱侧弯患者的椎体旋转和椎弓根直径与AIS患者相当；然而，CP脊柱侧弯的弦长较短。对于CP脊柱侧弯患者椎弓根螺钉的选择，应更多考虑椎弓根螺钉的长度而非直径。
