Cheung K M, Luk K D
The Duchess of Kent Children's Hospital, Hong Kong.
J Bone Joint Surg Am. 1997 Aug;79(8):1144-50. doi: 10.2106/00004623-199708000-00005.
We used a new method to assess spinal flexibility in thirty patients who were to be managed operatively for adolescent idiopathic scoliosis. The method involves placing the patient in the lateral decubitus position and bent over a fulcrum (a radiolucent padded cylinder) so that the spine is passively hinged open. For thoracic curves the fulcrum is centered under the rib corresponding to the apex of the curve, and for lumbar curves the fulcrum is placed directly under the apex. The preoperative workup for the thirty patients included an anteroposterior radiograph made with the patient standing, a lateral-bending radiograph made with the patient supine, and the new fulcrum bending radiograph. All patients were treated with posterior spinal arthrodesis with segmental spinal instrumentation. The degree of flexibility obtained with the traditional and new methods was compared with the degree of correction observed on the radiograph made, with the patient standing, one week after the operation. Preoperatively, the mean Cobb angle was 58 degrees on the anteroposterior radiograph made with the patient standing, 31 degrees on the lateral-bending radiograph made with the patient supine, and 24 degrees on the fulcrum bending radiograph. The mean angle was 25 degrees on the anteroposterior radiograph made one week postoperatively, so the mean correction was 57 per cent. The difference between the mean angle on the lateral-bending radiograph and that on the postoperative radiograph was significant (p < 0.001); however, the mean angle measured on the preoperative fulcrum bending radiograph and the postoperative angle were almost identical. We found the fulcrum bending radiograph to be more predictive of the degree of flexibility and correctability than the lateral-bending radiograph in this group of patients who had segmental spinal instrumentation for correction of idiopathic scoliosis.
我们采用一种新方法评估了30例拟接受手术治疗的青少年特发性脊柱侧凸患者的脊柱柔韧性。该方法是让患者处于侧卧位，趴在一个支点（一个可透射线的软垫圆柱体）上，使脊柱被动地张开成铰链状。对于胸段曲线，支点位于对应曲线顶点的肋骨下方中央；对于腰段曲线，支点直接置于顶点下方。这30例患者的术前检查包括患者站立位的前后位X线片、患者仰卧位的侧屈位X线片以及新的支点弯曲位X线片。所有患者均接受了后路脊柱融合术及节段性脊柱内固定。将传统方法和新方法所获得的柔韧性程度与术后一周患者站立位时所拍摄X线片上观察到的矫正程度进行了比较。术前，患者站立位的前后位X线片上平均Cobb角为58度，仰卧位的侧屈位X线片上为31度，支点弯曲位X线片上为24度。术后一周的前后位X线片上平均角度为25度，因此平均矫正率为57%。侧屈位X线片上的平均角度与术后X线片上的平均角度之间差异有统计学意义（p<0.001）；然而术前支点弯曲位X线片测量的平均角度与术后角度几乎相同。在这组接受节段性脊柱内固定以矫正特发性脊柱侧凸的患者中，我们发现支点弯曲位X线片比侧屈位X线片更能预测柔韧性和可矫正程度。
