脊柱侧凸矫形预测方法评价

背景传统评价脊柱侧凸的方法有多种,例如仰卧位像、牵引像、俯卧位推压像以及侧方弯曲像等.近年来,支点弯曲像已成为术前评价脊柱柔韧度的新方法.目的比较站立位弯曲像、悬吊牵引像和支点弯曲像对脊柱侧凸矫形的预测作用与价值.设计随机对照研究.地点和对象研究在北京协和医院骨科完成.对象为该科收治的胸椎侧凸畸形患者27例,男10例,女17例;平均年龄15.4岁.干预全部病例术前行脊柱正侧位、站立位弯曲像、悬吊牵引像和支点弯曲像检查,采用后路脊柱侧凸矫形植骨融合术,第3代节段性内固定系统固定.主要观察指标脊柱正侧位、站立位弯曲像、悬吊牵引像和支点弯曲像以及术后正位像的Cobb角.结果①术后平均Cobb角为31°,较术前胸弯(平均Cobb角为61°)明显改善(t=1.706,P＜0.01),平均矫正率为51.6%.②3种检查方法均与术后胸弯Cobb角呈正相关(P＜0.01).③Fulcrum像与术后Cobb角差异无显著性意义(P＞0.05),其他两种方法与术后Cobb角差异有非常显著性意义(P＜0.01).结论①Fulcrum像可以用于评价胸弯的柔韧度,其效果优于站立位Bending像和悬吊牵引像.②分析脊柱侧凸畸形及预测脊柱侧凸的矫形需联合应用3种方法.

Evaluation of imaging methods for predicting the correction of scoliosis

BACKGROUND: Various imaging methods are used for scoliosis evaluation, such as supine, traction, push-prone and lateral-bending radiographs.In recent years, fulcrum bending radiograph has become a new method for assessing the spinal flexibility.OBJECTIVE: To compare the value of standing bending, suspension traction and fulcrum bending radiographs in the prediction of scoliosis correction.DESIGN: A randomized controlled study was performed.SETTING and PARTICIPANTS: The study was completed in the Department of Orthopaedics, Peking Union Medical College Hospital. Twenty-seven hospitalized patients with idiopathic scoliosis, including 17 females and 10males, were selected for the study, with a mean age of 15.4 years.INTERVENTIONS: Preoperatively, all of the patients had examinations with lateral whole-spine radiograph, lateral bending radiograph, suspension traction radiograph and fulcrum bending radiograph, before posterior spinal fusion surgery was performed for correcting idiopathic scoliosis, using segmental internal fixation system of the third generation.MAIN OUTCOME MEASURES: The Cobb angle was measured for each thoracic curve on preoperative lateral, active lateral bending, standing bending, traction, and fulcrum bending radiographs as well as on postoperative radiograph.RESULTS: The mean postoperative Cobb angle was 31° on radiograph,significantly improved in comparison with that of thoracic curves on the preoperative radiograph(61°, t = 1. 706, P ＜ 0.01), with a mean reduction by 51.6%. In the thoracic curves, the postoperative Cobb angle was positively correlated with the preoperative Cobb angle measured on the standing bending, traction and fulcrum bending radiographs( P ＜ 0. 01). There was no significant difference between the mean Cobb angle on fulcrum bending and that on postoperative radiograph( P ＞ 0. 05), and significant difference was found between the other two methods and the postoperative mean Cobb angle ( P ＜ 0. 01).CONCLUSION: The fulcrum bending radiograph can be used to assess the flexibility of the thoracic curve, and its effect is better than that of standing bending radiograph and traction radiograph; these three methods must be combined to analyze scoliosis and predict scoliosis correction.