摘要目的 评价长海支点侧屈位X线片在青少年特发性脊柱侧凸患者术前柔韧性评估中的作用和价值.方法 2012年6月至201 3年8月采用自行研制的可升降可测重长海支点侧屈位装置对37例青少年特发性脊柱侧凸患者的46个胸椎及腰椎侧弯进行术前影像学柔韧性评估,其中女性31例,男性6例;年龄10 ～ 19岁,平均15.0岁 评估内容包括术前站立前后位X线片、长海支点侧屈位X线片(基础支点侧屈位、最大支点侧屈位)、仰卧侧屈位X线片、传统支点侧屈位X线片以及术后1周站立前后位X线片.测量患者Cobb角并计算手术矫正率、侧弯柔韧性指数以及矫正指数.并测量长海最大支点高度、长海基础重量值和长海最大重量值.对术前几种评估方法的结果与术后矫形结果之间差异采用成对t检验,长海支点侧屈位柔韧性指数与手术矫正率、长海最大支点高度与长海最大重量、长海支点侧屈位支点高度变化与支点重量变化之间的相关性采用Pearson相关性及回归分析进行检验.结果 本组共包括46个结构性弯曲,其中28个主胸弯,1 8个胸腰弯/腰弯.46个被评估结构性弯曲在站立前后位X线片的术前平均Cobb角为47°±11°,术后1周平均Cobb角为1 1°±5°.仰卧侧屈位Cobb角(t=7.2,P=0.001)、传统支点侧屈位Cobb角(t=7.1,P=0.001)、长海基础支点侧屈位Cobb角(t=6.5,P=0.001)与术后站立前后位Cobb角相比差异有统计学意义;传统支点侧屈位Cobb角(t=11.0,P=0.001)、长海基础支点侧屈位Cobb角(t=13.6,P=0.001)与长海最大支点侧屈位Cobb角相比差异有统计学意义;而传统支点侧屈位Cobb角与长海基础支点侧屈位Cobb角相比差异无统计学意义(t=2.0,P =0.051),长海最大支点侧屈位Cobb角与术后站立前后位Cobb角相比差异无统计学意义(t=0.9,P=0.36) 长海最大支点高度平均为(29.6±1.4)cm,长海基础重量平均为(20±6)kg,长海最大重量值平均为(40 ±6)kg 28个主胸弯术前站立前后位Cobb角平均46°±1 1°,术后1周Cobb角平均12°±6°.18个胸腰弯/腰弯术前站立前后位Cobb角平均49°±12°,术后1周Cobb角平均10°±5°.两种侧弯的评估结果与整体数据评估结果一致.整体数据的相关性分析提示长海基础支点侧屈位柔韧性指数与手术矫正率呈正相关关系(r =0.67,r2=0.45,P =0.001),长海最大支点侧屈位柔韧性指数与手术矫正率也呈正相关关系(r=0.59,r2=0.35,P =0.001),长海最大支点侧屈位支点高度与支点上所测的最大重量呈正相关关系(r=0.69,r2=0.47,P=0.001),长海支点侧屈位支点高度变化与支点重量变化呈正相关关系(r=0.62,r2=0.38,P=0.001).结论 长海支点侧屈位X线片可以更好地反映青少年特发性脊柱侧凸患者的柔韧性,因此可以辅助脊柱侧凸患者的术前柔韧性评估.与传统的支点侧屈位X线片及仰卧侧屈位X线片相比,长海最大支点侧屈位X线片的结果更接近椎弓根螺钉系统矫形的结果.

abstractsObjective To evaluate the role and value of Changhai fulcrum bending radiograph (CH-FBR) in curve flexibility assessment of adolescent idiopathic scoliosis (AIS) patients.Methods Thirty-seven AIS patients treated between June 2012 and August 2013 were enrolled,including 31 female and 6 male patients whose age ranged from 10 to 19 years,averaged of 15.0 years.The assessment of radiographs included preoperative standing posterior-anterior radiograph,supine side-bending radiograph,traditional fulcrum bending radiograph,Changhai fulcrum bending radiograph and postoperative standing posterior-anterior radiograph.Postoperatively,radiographs were assessed at one week.The CH-FBR was performed at the lowest height and the optimized height which means the weight on the fulcrum touch the maximum.All measurements of angle were made with use of the Cobb method.The flexibility of the curve as well as the correction rate and fulcrum bending correction index (FBCI) were calculated for all patients.Themaximum height of CH-FBR,basic weight and maximum weight were measured for all AIS.Paired t-tests were used to assess differences between preoperative and postoperative curves within group samples.The Pearson correlation coefficients were calculated using bivariate analysis between CH-FBR flexibility rate and correction rate,the maximum height of CH-FBR and maximum weight,the height changes of CH-FBR and weight changes.Results A total of 46 curves were involved in this study,including 28 thoracic and 18 thoracolumbar/lunbar curves.Preoperatively,the mean Cobb angle of the 46 structural curves was 47° ± 11°.Postoperatively,the mean Cobb angle was 11° ±5°.Cobb's angle in supine side-bending(t =7.2,P =0.001),traditional fulcrum bending (t =7.1,P =0.001) and lowest height of Changhai fulcrum bending (t=6.5,P =0.001) were significantly different from the postoperative Cobb angle; Cobb's angle in traditional FBR (t =11.0,P =0.001) and lowest height of Changhai fulcrum bending (t =13.6,P =0.001) were significantly different from the optimized height CH-FBR Cobb angle.There was no significant difference found between traditional FBR Cobb angle and lowest height CH-FBR Cobb angle (t =2.0,P =0.051),optimized height CH-FBR Cobb angle and postoperative Cobb angle(t =0.9,P =0.36),lowest height CH-FBR Cobb angle and traditional FBR Cobb angle(t =2.0,P =0.051).The maximum height of CH-FBR,basic weight and maximum weight were (29.6 ± 1.4)cm,(20 ±6)kg,and(40 ±6)kg.Preoperatively,the mean Cobb angle of the 28 structural curves (main thoracic curves) was 46° ± 11°.Postoperatively,the mean Cobb angle was 12° ± 6°.Preoperatively,the mean Cobb angle of the 18 structural curves(thoracolumbar/lunbar curves) was 49° ± 12°.Postoperatively,the mean Cobb angle was 10° ± 5°.The results were same in 28 structural curves,18 structural curves as well as 46 curves.Correlation analysis of 46 curves indicated that the maximum height of CH-FBR positively correlated with maximum weight (r =0.69,2r =0.47,P =0.001),the height changes of CH-FBR positively correlated with weight changes on CH-FBR (r =0.62,r2 =0.38,P =0.001).Conclusions CH-FBR is a more reliable and effective method than traditional FBR and supine side-bending for curve flexibility evaluation in AIS patients.Moreover,compared to the traditional FBR and side-bending radiograph,the flexibility suggested by the optimized height CH-FBR more closely approximates the postoperative result made by pedicle screws fixation and fusion.