The association of disproportionate skeletal growth and abnormal radius dimension ratio with curve severity in adolescent idiopathic scoliosis

Abnormal anthropometric measurements during the peripubertal growth spurt have been documented in adolescent idiopathic scoliosis (AIS). Magnetic resonance (MR) imaging studies of the spine have suggested a disproportionate endochondral and membranous ossification in AIS. The present study aimed at investigating whether disproportional ossification and skeletal growth occurred in the peripheral bone of AIS patients using the radius as the target bone. Skeletally mature AIS girls with different severity (n = 290) and age-matched control healthy girls (n = 80) were recruited. The anthropometric parameters were recorded. The midshaft of non-dominant radius was scanned with peripheral quantitative computed tomography (pQCT) and the radius diameter was calculated from the cross-sectional area. Radius dimension ratio was derived from the ratio of radius diameter to radius length. The anthropometric parameters were compared between AIS and control with adjustment for age. The radius dimension ratio was further correlated with curve severity in AIS girls using Pearson’s correlation test. The analysis showed that the arm span and radius length were slightly longer in AIS girls. The BMI of AIS girls was significantly lower than the controls. The radius dimension ratio in severe AIS girls was significantly lower than the controls and the ratio of AIS girls correlated with the curve severity (r = −0.120; p = 0.039). The abnormal radius dimension ratio supported the presence of systemic growth abnormalities in AIS. Disproportional endochondral-membranous ossification could explain for the observation. The observation of the association of radius dimension ratio with curve severity provides an important potentially clinically measurable parameter for further longitudinal studies on the prognostication of curve progression in AIS.     

青少年特发性脊柱侧凸青春期生长发育形态学特征

目的探讨青少年特发性脊柱侧凸(adolescentidiopathicscoliosis,AIS)患儿青春期生长发育的形态学特征。方法对256例12～16岁(平均14.1岁)AIS女性患儿及462例12～16岁(平均14.3岁)健康非侧凸女孩的大体形态学资料进行分析。AIS诊断标准为冠状面上>10°的脊柱侧凸畸形。观测指标包括身高、坐高、臂长及月经状况。采用Bjure公式计算校正身高及校正坐高。AIS组及对照组的各项指标进行比较分析。结果AIS组与对照组的年龄构成比较,差异无统计学意义(P>0.05)。从研究群体看,AIS组的身高、坐高以及臂长与对照组比较,差异无统计学意义(P>0.05),但校正身高、校正坐高显著高于对照组(P<0.01),且月经来潮早于对照组(P<0.01)。从各年龄组看,12岁时,AIS组的校正身高、校正坐高、臂长与对照组相比差异无统计学意义(P>0.05),甚至AIS组校正前平均身高低于对照组。13～15岁,AIS组的校正身高、校正坐高、臂长显著高于对照组(P<0.01)。16岁时,虽然AIS组的校正身高及校正坐高略高于对照组(P<0.05),但身高、坐高以及臂长与对照组比较差异无统计学意义(P>0.05)。结论AIS患儿青春期生长发育存在形态学的异常,这可能与其发病机制有关。     

Generalized low areal and volumetric bone mineral density in adolescent idiopathic scoliosis.

Adolescent idiopathic scoliosis (AIS) may be associated with generalized low bone mineral status. The bone mineral density (BMD) of 75 girls of 12-14 years of age and diagnosed as having AIS were compared with 94 age-matched female control subjects. Areal BMD (aBMD) of the lumbar spine (L2-L4) and the bilateral proximal femur were measured using-energy X-ray absorptiometry (DEXA), and volumetric BMD (vBMD) of the nondominant distal radius and bilateral distal tibias was measured with peripheral quantitative computer tomography (pQCT). Relevant anthropometric parameters and the severity of the spinal deformity (Cobb's angle) also were evaluated and correlated with the BMD measurements. Results revealed the presence of a generalized lower bone mineral status in AIS patients. Detailed analysis showed that the aBMD and vBMD measured at the bilateral lower extremities were significantly lower in AIS patients when compared with the same in the normal controls. The most significant effect was seen in the trabecular BMD (tBMD) of the distal tibias. Of all the AIS girls, 38% of the aBMD and 36% of the vBMD were below -1 SD of the normal. BMD was found to correlate better with "years since menarche" (YSM) than with chronological age. When the BMD was evaluated for the 3 YSM groups, aBMD of the proximal femur and tBMD of distal tibias were found to be significantly lower in the AIS patients. Neither the aBMD nor the vBMD of AIS patients was found to be associated with the severity of spinal deformity. In addition, anthropometric measurements showed significantly longer arm span and lower extremities in the AIS girls. We concluded that the AIS girls had generalized lower aBMDs and vBMDs.     

雌激素β受体基因多态性与青少年特发性脊柱侧凸关系的研究

目的 比较分析青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者与对照组雌激素β受体(estrogen β receptor,ER β)基因型分布情况,探讨ER β基因多态性与AIS患者易感性、异常生长模式及低骨量之间的关系.方法 对2006年3月至2007年3月的288例(男17例,女271例)AIS患者进行人体形态学测量,记录其年龄、身高、体重、臂长、月经初潮情况、Cobb角、Risser征等指标,并收集其静脉血标本.经体检收集232名(男30名,女202名)健康青少年静脉血标本.应用聚合酶链反应-限制性片断长度多态性技术(PCR-RFLP)检测分析AIS组及正常青少年组ER β基因型,比较两组间及AIS组内各亚组ER β基因型分布情况.结果 AIS组与对照组ER β基因型分布差异无统计学意义(χ2=5.908,P＞0.05).AIS组内比较,初潮年龄≥12岁组Rr型频率高于初潮年龄＜12岁组(P＜0.05),而根据身高、体重指数(BMI)、臂长、Cobb角、Risser征等分组,基因型分布比较差异无统计学意义(P＞0.05).ER B基因两个多态性位点各基因型间所对应的骨密度比较差异无统计学意义(P＞0.05).结论 ER β基因多态性与AIS患者易感性无关联.Rr型患者存在初潮延迟现象,可能在AIS的进展中起一定作用.ER β基因多态性与骨量无相关,可能在AIS的低骨量中不起作用.     

Timing of menarche in Chinese girls with and without adolescent idiopathic scoliosis: current results and review of the literature

Age at menarche is closely related to scoliosis progression during adolescence. Current data concerning the timing of menarche between scoliotic and non-scoliotic girls in the literature are conflicting, with inconclusive results. The aim of this study was to investigate the distribution difference of age at menarche for adolescent idiopathic scoliosis (AIS) girls and normal control population and to subsequently elucidate the menarche age difference through literature reviewing. Moreover, menarche age of AIS girls with Cobb angle <40°, 40–60°, >60° were compared to estimate its association with curve severity. Menstrual status data were available for 6,376 healthy female adolescents and 2,196 AIS girls. We notice that less than 10% of healthy Chinese girls experienced onset of menses before 11.38 years, and approximately 90% of healthy Chinese girls were menstruating by 13.88 years, with a median age of 12.63 years. As for AIS girls, less than 10% started to menstruate before 11.27 years, and approximately 90% were menstruating by 14.38 years, with a median age of 12.83 years. Average menarche age in AIS (12.83 ± 1.22 years) was significantly later than that of normal control girls (12.63 ± 0.98 years) (p < 0.001). Age at menarche for AIS affected girls was significantly greater than that of normal control girls at 75%, 90% of whom had attained menarche (p = 0.001, p < 0.001). Proportion of girls starting to menstruate after 14 years was significantly higher in AIS population compared with normal controls (16.3 vs. 8.1%, p < 0.001). In addition, AIS girls with Cobb angle >60° experienced onset of menses at an average age of 13.25 years, which was significantly later than AIS girls with Cobb angle <40° (12.81 years, p < 0.05) and marginally significantly later than AIS girls with Cobb angle between 40 and 60° (12.86 years, p = 0.053). In conclusion, a tendency of delayed onset of menarche was observed in Chinese idiopathic scoliotic girls in this large sample study, especially for girls with Cobb angle >60°, which is supported by multiple previously established positive linkages on AIS etiology studies. Accordingly it is believed that late menarche may contribute importantly to abnormal pubertal growth and subsequently modulate curve behavior in AIS.     

青少年特发性脊柱侧凸患者脊柱柔韧性的影响因素

目的:探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者脊柱柔韧性的可能影响因素.方法:选取2006年12月～2008年4月在我院脊柱外科手术治疗的204例AIS患者,男性36例,女性168例,平均年龄15.0岁;平均Cobb角50.1°;平均Risser征3.4度;主弯跨度平均6.8个椎体;主弯顶椎旋转度平均2.0度.摄站立位全脊柱正侧位及仰卧左右侧屈位X线片,计算主弯柔韧性.采用相关分析研究各临床指标与主弯柔韧性的相关性.结果:女性AIS患者的脊柱柔韧性明显高于男性(P<0.05);胸腰弯组和腰弯组AIS患者的脊柱柔韧性显著大于胸弯组(P<0.05),胸腰弯和腰弯组之间无显著性差异(P>0.05).女性AIS患者中的年龄及主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05),且胸弯女性AIS患者的月经初潮至手术时间及顶椎旋转度也与脊柱柔韧性显著负相关(P<0.05).男性胸弯AIS患者中侧屈位主弯Cobb角、胸腰弯/腰弯组中主弯Cobb角(站立位与侧屈位)均与脊柱柔韧性显著负相关(P<0.05).主弯跨度及Risser征与脊柱柔韧性均无明显相关性(P>0.05).结论:女性AIS患者脊住柔韧性受年龄、月经初潮至手术时间、主弯Cobb角(站立位与侧屈位)、弯型及顶椎旋转度等因素影响;男性AIS患者的脊柱侧凸柔韧性主要受主弯Cobb角及弯型影响.     

女性青少年特发性脊柱侧凸患者生长高峰预测因素的组织学评价

目的通过组织学研究来评价青少年特发性脊柱侧凸女性患者生长高峰预测因素的价值。方法收集青少年特发性脊柱侧凸女性患者的髂软骨标本,垂直钙化层进行切片染色,并对其增殖活性进行分级。将患者年龄、月经、腕骨骨龄、肘关节骨龄、指骨骨龄及Risser征进行分级,比较各级间患者髂软骨增殖活性的差异。结果共收集53例患者骨标本,平均年龄14．0岁。通过组织学分析发现年龄〉13．0岁、月经来潮、腕骨骨龄〉14．0岁及Risser征Ⅲ级的患者增殖活性下降。结论年龄〉13．0岁、月经来潮、腕骨骨龄〉14．0及Risser征Ⅲ级均可用于判定青春期生长高峰结束;年龄11．0岁、乳房开始发育、腕骨骨龄12岁可用于预测PHV的开始。     

Uncoupled neuro-osseous growth in adolescent idiopathic scoliosis? A preliminary study of 90 adolescents with whole-spine three-dimensional magnetic resonance imaging

Previous literatures revealed abnormal cross-sectional morphology of spinal cord in AIS, suggesting the presence of disproportional growth between the neural and skeletal system. No accurate measurement of whole spine by MRI multiplanar reconstruction and their correlation with Cobb angle were studied. In this study, MRI three-dimensional reconstruction of the whole spine was performed in 90 adolescents (49 AIS with thoracic/thoracolumbar curve, and 41 age-matched healthy controls). Measurements of the ratio of anteroposterior (AP) and transverse (TS) diameter of the cord, the concave and convex lateral cord space (LCS) were obtained at the apical level in AIS patients. Cerebellar tonsillar level related to the basion-opsithion line, location of conus medullaris, cord length, vertebral column length, cord/vertebral column length ratio were obtained. All of the same parameters were also measured in healthy controls at matched vertebral levels and their correlations with Cobb angle were made. We notice that AP, TS, AP/TS and LCS ratio were increased in AIS subjects with low-lying position of cerebellar tonsillar level and elevating position of conus medullary when compared with healthy controls (P < 0.01). AP, AP/TS and LCS ratio were correlated significantly with Cobb angle (P < 0.05). Cord length and vertebral column length were not significantly different between AIS and control group. However, cord/vertebral column length ratio was significantly smaller in AIS group (P < 0.01). Cord length, vertebral column length and cord/vertebral column length ratio were not related with age or Cobb angle (P > 0.05). These data suggest the presence of uncoupled neuro-osseous growth along the longitudinal axis of spinal cord with associated morphologic changes of cross-sectional configuration and relative position of the cord. Some changes are significantly relevant with Cobb angle, which may indicate pathogenesis of AIS.     

青少年特发性脊柱侧凸患者胰岛素样生长因子-1受体基因多态性研究

目的 探讨胰岛素样生长因子-1受体(IGF-1R)基因多态性与青少年特发性脊柱侧凸(AIS)易感性之间的关联性.方法 实验对象为200例MS患者(AIS组)和200名年龄、性别匹配的健康青少年(对照组),记录AIS组的身高、体蓖、月经初潮年龄(女性)、侧弯类型、最大Cobb角和Risser征等临床指标.采用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)的方法对所有研究对象进行IGF-1R基因分型,比较不同基因型在AIS组和对照组之间的分布差异,并分析基因多态性与临床指标的相关性.结果 AIS组与对照组的IGF-1R基因等位基因及基因型分布无统计学差异(P＞0.05).女性AIS患者不同基因型所对应的最大Cobb角、Risser征及月经初潮年龄之间差异也无统计学意义(P＞0.05).结论 IGF-1R基因多态性与AIS的发生发展均无相关性.     

Generalized low bone mass of girls with adolescent idiopathic scoliosis is related to inadequate calcium intake and weight bearing physical activity in peripubertal period

Generalized low bone mass has been well documented in patients with adolescent idiopathic scoliosis (AIS). However, studies linking calcium-intake (CA), weight-bearing physical-activity (PA) and bone mass of AIS are lacking. We aimed to study the relationship between CA, PA and bone mass in AIS girls and compared to those of healthy non-AIS controls during the peripubertal period. Newly diagnosed AIS girls (n=596) aged 11–16 years with Cobb angle 10° were recruited to compare with age-matched healthy girls (n=302) in a cross-sectional study. Anthropometric parameters, pubertal status, CA and PA were assessed. Areal bone mass of lumbar spine and femoral neck, and volumetric bone mass of distal radius and tibia were determined by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography, respectively. The results showed that weight and body mass index (BMI) of AIS were lower than the controls (P<0.05). Corrected height and arm span of AIS were longer than those of controls from 13 years onwards (P<0.02). Median CA of AIS was <410 mg/day across the ages and did not differ from the controls (P=0.063). Median PA of AIS (1.6 h/day) was lower than the controls (1.8 h/day) (P=0.025). Bone mass of AIS was on average 6.5% lower than controls across the ages (P<0.05). CA and PA were significantly correlated with bone mass of AIS (P<0.04). Multivariate analysis showed that AIS in girls was associated with lower bone mass, and that both CA and PA were independent predictors of bone mass in AIS. In conclusion, AIS girls were found to have lower body weight and BMI, longer segmental lengths and generalized low bone mass. Inadequate calcium intake and weight-bearing physical activity were significantly associated with low bone mass in AIS girls during the peripubertal period. The importance of preventing generalized osteopenia in the control of AIS progression during the peribubertal period warrants further study.     

青少年特发性脊柱侧凸女性患者瘦素基因启动子区-2548G/A基因多态性研究

目的:探讨瘦素基因启动子区-2548G/A(rs7799039)基因多态性与女性青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)发生发展、异常生长模式及侧凸类型之间的相关性。方法:收集451例AIS女性患者及335例正常同龄女性青少年的静脉血标本,采用PCR-RFLP方法对两组的瘦素基因启动子区-2548G/A(rs7799039)多态性位点进行基因分型,比较两组间基因分型的差异,分析AIS组中基因分型与患者Cobb角和人体测量学指标的关系。结果:AIS组rs7799039位点基因型和等位基因频率与正常对照组之间无明显差异;在AIS组内,rs7799039位点不同基因型所对应的初诊Cobb角、校正身高、BMI、月经初潮年龄及Risser征均没有显著性差异;rs7799039位点等位基因多态性分布情况在不同侧凸类型AIS患者和对照组之间无统计学差异。结论:瘦素基因启动子区-2548G/A(rs7799039)基因多态性与女性AIS的发生发展、异常生长模式及不同侧凸类型之间都没有明显的相关性。     

Relative anterior spinal overgrowth in adolescent idiopathic scoliosis. Results of disproportionate endochondral-membranous bone growth

We undertook a comparative study of magnetic resonance imaging (MRI) vertebral morphometry of thoracic vertebrae of girls with adolescent idiopathic thoracic scoliosis (AIS) and age and gender-matched normal subjects, in order to investigate abnormal differential growth of the anterior and posterior elements of the thoracic vertebrae in patients with scoliosis. Previous studies have suggested that disproportionate growth of the anterior and posterior columns may contribute to the development of AIS. Whole spine MRI was undertaken on 83 girls with AIS between the age of 12 and 14 years, and Cobb's angles of between 20 degrees and 90 degrees, and 22 age-matched controls. Multiple measurements of each thoracic vertebra were obtained from the best sagittal and axial MRI cuts. Compared with the controls, the scoliotic spines had longer vertebral bodies between T1 and T12 in the anterior column and shorter pedicles with a larger interpedicular distance in the posterior column. The differential growth between the anterior and the posterior elements of each thoracic vertebra in the patients with AIS was significantly different from that in the controls (p < 0.01). There was also a significant positive correlation between the scoliosis severity score and the ratio of differential growth between the anterior and posterior columns for each thoracic vertebra (p < 0.01). Compared with age-matched controls, the longitudinal growth of the vertebral bodies in patients with AIS is disproportionate and faster and mainly occurs by endochondral ossification. In contrast, the circumferential growth by membranous ossification is slower in both the vertebral bodies and pedicles.     

Association of osteopenia with curve severity in adolescent idiopathic scoliosis: a study of 919 girls

Generalized osteopenia and spinal deformity occur concomitantly in adolescent idiopathic scoliosis (AIS) during the peripubertal period. No large-scale study has been performed to reveal the link between scoliotic deformity and bone-mineral status in AIS. In a cross-sectional study, the extent of scoliotic-curve severity in relation to bone-mineral status was examined for 619 AIS girls and compared with those of 300 healthy non-AIS counterparts aged 11–16 years. Curve severity was categorized into a moderate (10–39°) and a severe group (40°) based on Cobb angle. Anthropometric parameters, bone mineral-density (BMD) and bone mineral-content (BMC) of lumbar spine, proximal femur and distal tibia were determined by dual-energy X-ray absorptiometry and peripheral QCT. Differences in anthropometric parameters and bone mass among control and the AIS-moderate and AIS-severe groups were tested by one-way ANOVA. Association between Cobb angle and bone mass was determined by univariate and multivariate analyses. Mean Cobb angle of the moderate and severe groups were 25±6.3° and 50.2±11.3°, respectively. Arm span and leg length among the moderate and severe AIS subjects were almost all longer than for the controls from age 13 years. Age-adjusted arm span and leg length were significantly correlated with curve severity ( p <0.015). Starting from age 13 years, most axial and peripheral BMD and BMC of the moderate or severe AIS group was significantly lower than for the controls ( p <0.029). Age-adjusted Cobb angle was inversely correlated with BMD and BMC of the distal tibia and lumbar spine among AIS subjects ( p 0.042). The proportion of osteopenic AIS girls in the severe group was significantly higher than that in the moderate group ( p 0.033). Multivariate analysis indicated that Cobb angle was inversely and independently associated with axial and peripheral BMD and BMC ( p 0.042). To conclude, curve severity was an inverse and independent associated factor on bone mineral mass of AIS during peripuberty. The study implied that prevention of osteopenia could be as important as controlling spinal progression in the management of AIS.     

不同Risser征定义对女性青少年特发性脊柱侧凸生长潜能评估的比较

 目的通过评价髂软骨的增殖活性, 比较 Risser征的美国方法和法国方法评估女性青少年特发性脊柱侧凸 (adolescent idiopathic scoliosis, AIS)生长潜能的价值。方法 选择需要行后路脊柱侧 凸矫形并取髂骨植骨的女性 AIS患者, 在前后位骨盆 X线片上按照美国方法和法国方法读取 Risser 征, 在患者髂软骨组织切片上对其增殖活性进行组织学分级(histologic grades, HGs)。分析两种 Risser征 的一致性, 并比较两者与 HGs的相关性。采用受试者工作特征(receiver operating characteristic, ROC)曲 线方法寻找判断患者生长成熟的最佳参数。结果 共收集有效标本 53份, 患者平均年龄 14.0岁。两种 Risser征的一致性较低, Risser征美国方法与 HGs的相关性较好。 Risser征美国方法5级或法国方法 4 级的患者髂软骨无明显增殖活性, 提示生长停止;此外年龄>16岁或月经年龄逸3岁亦提示生长停止。 根据 ROC曲线分析, 将上述参数结合发现 Risser征美国方法 4~5级且月经年龄逸2岁亦可用于判断生长停止, 该方法特异性为 100%, 准确度亦较其他单个参数高;该方法确定患者生长停止时平均年龄为 15.2岁, 较其他方法提前 0.9~1.4岁。结论 Risser征美国方法更适用于评估女性 AIS患者的发育成熟 情况;其与月经年龄结合应用可提高判断患者生长停止的准确度, 且有助于提早支具治疗停止的年龄。     

Matrilin-1基因多态性对青少年特发性脊柱侧凸进展的预测价值

目的 探讨Matrilin-1基因多态性在预测青少年特发性脊柱侧凸(adolescent idiopathicscoliosis,AIS)是含进展为严重脊柱侧凸方面的价值.方法 2006年6月至2007年3月在我院就诊的AIS患者267例,男40例,女227例.104例手术治疗,163例定期门诊随访,记录患者末次随访或术前最大Cobb角、初潮年龄、侧凸弯型、身高、臂长及体重.选取Matrilin-1基因启动子区域位点rs1149048进行聚合酶链式反应-限制性片段长度多态性(polymerase chain reaction-restriction fragment length poly-morphism,PCR-RFLP)基因分型.进展型侧凸(脊柱侧凸进展成为严重脊柱侧凸)定义为骨骼发育未成熟时Cobb角>40°或骨骼发育成熟时Cobb角>50°.AIS患者被分为进展型与非进展型两组,比较两组间的临床特征及基因型分布的差异.分析侧凸进展的危险因素.结果 267例AIS患者中162例(60.7%)为非进展型,105例(39.3%)为进展型.进展型组月经初潮年龄较晚(>13岁),且三弯及胸腰双主弯所占比例高,基因型GG的个体在进展型组比例高(55.2%).初潮年龄晚、三弯、胸腰双主弯及基因型CG为侧凸进展的危险因素.结论 Matrilin-1基因多态性可被用来预测AIS进展,结合其他相关预测因素可提高预测的准确性.     

青少年特发性脊柱侧凸女性患者的体重指数特征

目的 探讨青少年特发性脊柱侧凸(AIS)女性患者与同年龄段健康女性在体重及体重指数(BMI)方面的差异.方法 选择2005年1月至2007年1月就诊的613例AIS女性患者(病例组)以及449例同年龄段健康女性(对照组)进行研究,所有研究对象年龄12～16岁.观察指标包括身高、体重以及出生年月,根据上述指标计算出校正身高、BMI以及校正BMI.病例组的校正身高根据最大Cobb角采用Sjure公式进行校正.采用独立样本t检验对病例组及对照组的身高、体重、BMI以及校正BMI进行比较.结果 病例组平均最大Cobb角为(31±11)(11～77)°.在每个年龄段,病例组的校正身高均高于对照组(P＜0.05),体重低于对照组(P＜0.01).病例组12、13、14、15及16岁患者的BMI分别为(17.6±1.9)、(17.9±2.5)、(17.9±2.1)、(18.6±2.3)和(19.0±1.9)kg/m2;而对照组对应年龄女性的BMI分别为(19.5±3.4)、(19.8±3.0)、(20.4±2.9)、(20.4±2.8)和(20.2±2.2)kg/m2,均高于病例组(P＜0.01).结论 进入青春期后,AIS女性患者比同年龄段正常女性偏高偏瘦;BMI比同年龄段正常女性偏低,提示AIS女性患者在青春期存在异常生长模式.     

青少年特发性脊柱侧凸大弯度患者脊髓圆锥位置的MRI研究

目的探讨青少年特发性脊柱侧凸(AIS)患者的脊髓圆锥位置及其与患者年龄、性别、侧凸严重程度和侧凸模式之间的关系。方法对202名 Cobb 角40°以上的 AIS 患者和52名对照组青少年进行腰椎 MRI 扫描,在矢状面自旋回波 T1WI 序列图像上,观测脊髓圆锥末端的位置,并根据圆锥末端与相邻的椎体的上、中、下1/3和椎间盘的对应关系进行定位。结果 AIS 组和对照组青少年的圆锥位置范围分别为 T_(12)中1/3～L_(2/3)椎间盘和 T_(12)下1/3～L_2下1/3,平均位置则均为 L_1下1/3水平。两组间圆锥位置分布无统计学差异。这两组青少年的圆锥位置不受年龄和性别的影响。在AIS 组内,圆锥位置与侧凸的严重程度和侧凸模式无显著相关性。结论 AIS 患者的圆锥位置分布与对照组相当,圆锥位置不受年龄、性别、侧凸严重程度和侧凸模式等影响。这提示,圆锥位置的改变不能用于对 AIS 的发病及进展的研究。     

青少年特发性脊柱侧凸的全脊柱三维MRI特点及与侧凸严重度相关性研究

目的 研究青少年特发性脊柱侧凸(adolescent idiopathic seoliosis,AIS)的MRI特征性变化,探讨AIS的MRI特征性变化与侧凸严重度的相关性.方法 应用三维莺建MRI技术对90例青少年(49例AIS,41名健康青少年)进行全脊髓脊柱和后脑MR检查.测量颈椎和胸椎各节段的脊髓最大前后径(AP)、最大横向直径(TS)和凸凹侧脊髓旁间隙(LCS)、小脑扁桃体与枕骨大孔基线的距离、齿突与枕骨大孔基线的距离、颈髓中轴线与延髓中轴线夹角(α)、枕骨大孔基线与延髓中轴线夹角(β)、脊髓面积、椎管面积、脊髓椎管面积比,测量脊髓全长、脊柱全长、脊髓脊柱全长比.结果 与健康对照组相比,AIS患者的AP、TS、AP/TS 和LCS比值明显增加,小脑扁桃体位置相对枕骨大孔明显下移,脊髓圆锥位置相对上移,β角减小,脊髓椎管面积比增大(P＜0.01);AIS组与对照组相比,全脊髓或全脊柱长度差异无统计学意义,但脊髓脊柱全长比明显减小(P＜0.01),与Cobb角无明显相关性.AP、AP/TS和LCS比值与Cobb角明显正相关(P＜0.05).结论 AIS患者在脊髓和脊柱的横断面上存在显著性形态学异常,部分与Cobb角有明显正相关;脊髓和脊柱纵轴上存在明显的脊髓牵拉受限,提示可能存在神经系统和骨骼系统的生长不平衡,这些可能与AIS的发病机制有关.     

Clinical investigation and imaging

Adolescent idiopathic scoliosis (AIS) affects 2–4 % of children and is diagnosed between age 10 and skeletal maturity. The female to male ratio for mild curves less than 20° is 1.5:1; however, progression to a severe deformity occurs more often in females (Weinstein in JAMA 289(5):559–567, 2003). Despite significant ongoing research, including into the genetic basis for AIS, there are currently no identifiable causes, and therefore the disorder still remains a diagnosis of exclusion. History, physical examination and radiographic assessment must exclude other possible causes of spinal deformity and are crucial in predicting the risk of curve progression. History should focus on family history, menarche, presence or absence of pain, sports activities and neurologic changes. Physical examination concentrates on anthropometric data, pubertal staging, neurologic testing and specific investigation of the spine, with the Adams’ forward bending test being the most meaningful step to evaluate trunk rotation. Definitive diagnosis cannot be made without imaging. The gold standard remains plain radiography with assessment of the Cobb angle on a standing coronal radiograph of the entire spine. A lateral X-ray is used for assessing sagittal balance and for evaluating the deformity in the sagittal plane. If available, surface topography can accompany the follow-up in AIS, reducing the radiation exposure. The role of magnetic resonance imaging (MRI) in AIS is an ongoing matter of debate. Common indications for MRI are the presence of an atypical curve pattern and abnormal neurological findings.     

Anthropometric data relating to normal and scoliotic Scandinavian girls

The increase in height and weight and the age at the menarche have been determined in girls with idiopathic scoliosis and in age-matched normal girls. The scoliotic girls were classified according to the position of the curve. The menarche was found to occur significantly later in girls with either a thoracolumbar or a double primary curve than in the control group; it was also significantly later in those two groups combined than in the girls with a right convex thoracic curve. At the time of the menarche, the girls with a thoracolumbar or a double primary curve were significantly taller than those in the control group. The girls with a double primary curve, and these together with girls with a thoracolumbar curve, were also significantly taller than those with a right convex thoracic curve. Those in the control group were significantly heavier, and in some age groups significantly taller, than children born during the period 1953-1958 and providing earlier Swedish research data. The average age at the menarche did not differ from that for a normal population for this country. The observed differences between the group with a right convex thoracic curve and that with a thoracolumbar or a double primary curve indicate that the pathomechanism, and even the etiology, may vary with the form of idiopathic scoliosis.