不同上肢体位对正常人和青少年特发性脊柱侧凸患者站立位脊柱矢状面形态的影响

目的 探讨不同上肢体位时,脊柱侧位片上脊柱区域和整体的形态变化,并确定上肢何种体位能更正确地反映脊柱的矢状位形态.方法 研究对象包括特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)胸弯患者21例和正常青少年志愿者13名.均摄站立位脊柱全长正位X线片及上肢平举及上肢抱胸两种体位的侧位X线片.侧位X线片上测量的参数指标包括:(1)线性距离指标.T1与C-铅垂线(C7 plumb line,C7PL)的距离、胸椎后凸顶点与C7PL的距离、L1与C7PL的距离、腰椎前凸顶点与C7PL的距离、骶骨后上缘与C7PL的距离(SVA);(2)区域前凸及后凸角度的指标.T2～5、T5～12、T10～L2、T1～12、L1～S1、上胸椎后凸(T1上缘与水平线的夹角)、下胸椎后凸(T12下缘与水平线的夹角)、上腰椎前凸(L1上缘与水平线的夹角)、下腰椎前凸(S1上缘与水平线的夹角);(3)骨盆的形态参数:骨盆倾斜角(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、骨盆投射角(pelvic incidence,PI).分别对AIS组及正常组就不同上肢体位时参数的测量结果进行配对t检验.结果 当上肢平举时,AIS组及正常组的腰椎前凸顶点与C7PL的距离、SVA及上胸椎后凸角度均小于上肢抱胸时的测量结果,下胸椎后凸角度及上腰椎前凸角度大于上肢抱胸时的测量结果;另外当上肢平举时,AIS组的腰椎前凸(L1-S1)较上肢抱胸时增大,胸椎后凸顶点与C7PL的距离、L1与C7PL的距离较上肢抱胸减小.结论 双上肢抱胸体位可以更好地反映生理状况下脊柱的矢状面形态.

The influence of different arm position on the spinal sagittal profile in normal adolescents and adolescent idiopathic scoliosis

Objectives To evaluate regional and global changes in the sagittal profile of the spine on two standing radiographic positions and to determine which position represents a more functional stance for pre-operation sagittal balance evaluation.Methods This study included 21 patients with adolescent idiopathic thoracic scoliosis and 13 healthy adolescents.Measurements were obtained from standing lateral radiographs in two different standing positions:alms forward to 90° with elbows fully flexed versus elbows fully flexed with fists resting on clavicles.The following parameters were measured:(1)Distance parameters:distance between T1 and C7PL,distance between thoracic kyphosis apex and C7PL,distance between L1 and C7PL,distance between lumbar lordosis apex and C7PL,SVA;(2)Angle parameters:T2-5,T5-12,T10-L2,T1-12,L1-S1,upper arc of kyphosis,lower arc of kyphosis,upper arc of lordosis,lower arc of lordosis;(3)Pelvic parameters:pelvic tilt,sacral slope,pelvic incidence.Sagittal plane parameters were analyzed using paired-t test between AIS group and the control group in different arm position.Results In AIS group and the control group,there were more negative SVA,smaller distance between C7 plumb line and apex lumbar lordosis,and minor upper arc of thoracic kyphosis when the ams were in the forward flexed position compared to the fists on clavicles position.Meanwhile,the lower arc of thoracic kyphosis and upper arc of lumbar lordosis were bigger.In AIS group,there were larger lumbar lordosis,sinaller distance between C7 plumb line and the thoracic kyphosis apex and smaller distance between C7 plumb line and L1 when the arms were in the forward flexed position.Conclusion The status on clavicles position for lateral radiograph is more representative of the patient's functional balance with adequate lateral radiographic visualization of the spine.