Vaughan J J, Winter R B, Lonstein J E
Kentucky Spine Institute, Lexington, USA.
Spine (Phila Pa 1976). 1996 Nov 1;21(21):2469-73. doi: 10.1097/00007632-199611010-00012.
A study was done to evaluate the use of voluntary supine side bending radiographs and Risser table traction radiographs in adolescent patients undergoing posterior spinal fusion for idiopathic scoliosis.
To compare the usefulness of supine side bending and traction radiographs in assessing curve flexibility and determining fusion levels in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis.
Supine side bending radiographs have been used in the preoperative evaluation of idiopathic scoliosis to determine curve flexibility and fusion area. Traction films have been used to determine the flexibility of large curves and neuromuscular curves where active side bending is not possible. No study to date has compared the use of these films in patients with adolescent idiopathic scoliosis undergoing surgery.
Seventy-five patients with more than a 2-year follow-up period after surgery were included in this study. Preoperative radiographs included a standing posteroanterior and lateral film and both supine maximal voluntary side bending films and a traction film done on a Risser table. A preoperative review of these radiographs was done to determine curve flexibility and fusion levels. At follow-up evaluation, the patients were examined for any evidence of decompensation or "adding-on" of levels.
For curves less than 60 degrees, side bending radiographs showed greater curve correction than traction radiographs, whereas the opposite was true for curves greater than 60 degrees. For King I and II curves, side bending radiographs were superior for determination of lumbar curve flexibility and for distinguishing these two types of curves. On traction radiographs, the stable vertebra was 1.4 vertebral levels higher than on the standing film. When the fusion level was moved proximally because of the traction radiograph, decompensation or "adding-on" commonly occurred.
Supine bending radiographs are superior to traction radiographs for assessing curve flexibility except for curves more than 60 degrees. The selection of the distal extent of fusion based on the traction radiograph gave a large number of poor results. The selection of fusion levels in adolescent Idiopathic scoliosis is best determined by a combination of standing posteroanterior and lateral radiographs and the supine maximum voluntary bend films.
开展了一项研究，以评估在接受特发性脊柱侧凸后路脊柱融合术的青少年患者中使用自愿仰卧侧弯X线片和里塞尔牵引床牵引X线片的情况。
比较仰卧侧弯和牵引X线片在评估青少年特发性脊柱侧凸后路脊柱融合术患者的曲线柔韧性及确定融合节段方面的有用性。
仰卧侧弯X线片已用于特发性脊柱侧凸的术前评估，以确定曲线柔韧性和融合区域。牵引片已用于确定无法进行主动侧弯的大曲线和神经肌肉曲线的柔韧性。迄今为止，尚无研究比较这些片子在接受手术的青少年特发性脊柱侧凸患者中的使用情况。
本研究纳入了75例术后随访时间超过2年的患者。术前X线片包括站立位正位和侧位片，以及仰卧位最大自愿侧弯片和里塞尔牵引床上拍摄的牵引片。对这些术前X线片进行回顾，以确定曲线柔韧性和融合节段。在随访评估时，检查患者是否有失代偿或节段“增加”的迹象。
对于小于60度的曲线，侧弯X线片显示出比牵引X线片更大的曲线矫正，而对于大于60度的曲线则相反。对于King I型和II型曲线，侧弯X线片在确定腰椎曲线柔韧性和区分这两种类型曲线方面更具优势。在牵引X线片上，稳定椎体比站立位片高1.4个椎体节段。当由于牵引X线片而将融合节段向近端移动时，常发生失代偿或“增加”。
除了大于60度的曲线外，仰卧位弯曲X线片在评估曲线柔韧性方面优于牵引X线片。基于牵引X线片选择融合的远端范围会产生大量不良结果。青少年特发性脊柱侧凸融合节段的选择最好通过站立位正位和侧位X线片以及仰卧位最大自愿弯曲片相结合来确定。
