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不同进展程度的胸弯型特发性脊柱侧凸患者矢状面形态差异的比较研究

Comparison of the sagittal profiles between thoracic idiopathic scoliosis patients with different curve progression

摘要:

目的 比较不同进展程度的胸弯型特发性脊柱侧凸患者矢状面形态的差异并探寻与侧凸进展有关的危险因素.方法 研究对象选自2009年9月至2010年5月的83例胸弯型特发性脊柱侧凸患者,所有研究对象之前均未接受过任何治疗.根据侧凸进展程度分为3组:非进展组(NCP组),包括26例骨骼发育已成熟且Cobb角<40°的患者;中度进展组(MCP组),包括29例骨骼发育已成熟且Cobb角≥40°的患者;重度进展组(SCP组),包括28例骨骼发育尚未成熟但Cobb角≥40°的患者.矢状面测量指标包括胸椎后凸角、腰椎前凸角、骶骨倾斜角、骨盆入射角和骨盆倾斜角.三组之间的数据比较采用单因素方差分析.结果 NCP组的平均胸弯Cobb角显著小于MCP组和SCP组(均P<0.01),但MCP组和SCP组之间差异无统计学意义(P=0.619).NCP组的平均胸椎后凸角为19°±7°,MCP组为13°±6°,SCP组为8°±5°;SCP组显著小于MCP组(P=0.011)和NCP组(P<0.01),而MCP组的平均胸椎后凸角显著小于NCP组(P<0.01).其余四项指标在3组之间差异均无统计学意义(P>0.05).结论 胸椎后凸不足与胸弯型特发性脊柱侧凸患者的侧凸进展密切相关,而骨盆的矢状面形态可能与胸椎侧凸的进展无关.

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abstracts:

Objectives To compare the sagittal profiles between thoracic idiopathic scoliosis (IS) patients with different curve progression and to determine the risk factors associated with curve progression.Methods A total of 83 thoracic IS patients from September 2009 to May 2010 were included in this study and were divided into 3 groups according to different curve progression. All the patients did not receive any previous treatments. There were 26 skeletally mature patients whose Risser sign were 5 degree with Cobb angle < 40° in non-curve progression group (NCP group), 29 mature patients whose Risser sign were 5 degree with Cobb angle≥40° in moderate curve progression group (MCP group) and 28 immature patients whose Risser sign ≤3 degree with Cobb angle≥40° in severe curve progression group (SCP group). Five sagittal parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), pelvic incidence (PI) and pelvic tilt (PT) were measured on the lateral X-ray films. Analysis of variance was used to compare these parameters among the 3 groups. Results The average thoracic Cobb angle was significantly smaller in NCP group when compared with MCP group(P <0. 01) or SCP group (P <0. 01),but not significantly different between the 2 latter groups (P =0. 619). The average TK was 19°±7° in NCP group,13°±6° in MCP group and 8°±5° in SCP group. The average TK was significantly smaller in SCP group when compared with MCP group(P = 0. 011) or NCP group (P < 0. 01), while the average TK was significantly smaller in MCP group when compared with NCP group (P < 0. 01). None of the other 4 parameters showed any significant difference between the 3 groups (P > 0. 05). Conclusions Thoracic hypokyphosis is strongly associated with curve progression in thoracic IS patients. Pelvic sagittal profile may not be involved in the underlying mechanism of curve progression in thoracic IS patients.

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作者: 蒋军 [1] 邱勇 [1] 朱泽章 [1] 钱邦平 [1] 朱锋 [1] 毛赛虎 [1] 赵清华 [1]
期刊: 《中华外科杂志》2011年49卷9期 812-815页 MEDLINEISTICPKUCSCD
分类号: R6
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2011.09.013
发布时间: 2011-11-11
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