CAJ | 학술논문

目的研究Cobb角≥40°的男性青少年特发性脊柱侧凸(Adolescent idiopathic scoliosis,AIS)弯型和影像学特征及其临床意义.方法回顾性分析2008至2009年间在我院初诊并行手术治疗的AIS患儿影像学资料.根据术前站立位及Bending位X线片分析侧凸的弯型及范围,测量计算侧凸Cobb角、柔韧性、胸椎后凸等.将AIS患儿根据弯型的典型/不典型以及特征进一步分组,比较男女患儿弯型分布、各亚组间男女患儿的影像学特征的差异.结果本研究共纳入91例男性和260例女性AIS患儿,两者骨龄一致.男性不典型侧凸的比例明显高于女性患儿(20.9％比10.0％,P＜0.01).在具有典型侧凸的患儿中,不典型特征的分布无明显的性别差异；但与女性AIS相比,男性AIS具有较高比例的单胸弯(46.2％比33.8％,P＜0.01)及胸椎过度后凸(11.1％比2.0％,P＜0.01).在具有结构性胸弯的典型侧凸中,男性患儿的胸弯Cobb角及胸椎后凸均较女性患儿大,胸弯柔韧性较女性小.结论 Cobb角≥40°的AIS患儿的弯型、侧凸Cobb角及柔韧性、胸椎后凸均存在性别差异.男性AIS患儿中不典型侧凸的发病率明显高于女性患儿.典型侧凸患儿中,男性AIS单胸弯进展的概率可能较女性患儿高.男性AIS结构性侧凸较女性患儿僵硬可能与其支具治疗和手术矫形的效果较差有关；在具有结构性胸弯的男性AIS患儿中,胸椎过度后凸并不表明神经系统一定存在异常.
목적 연구Cobb각≥40°적남성청소년특발성척주측철(Adolescent idiopathic scoliosis,AIS)만형화영상학특정급기림상의의.방법 회고성분석2008지2009년간재아원초진병행수술치료적AIS환인영상학자료.근거술전참립위급Bending위X선편분석측철적만형급범위,측량계산측철Cobb각、유인성、흉추후철등.장AIS환인근거만형적전형/불전형이급특정진일보분조,비교남녀환인만형분포、각아조간남녀환인적영상학특정적차이.결과 본연구공납입91례남성화260례녀성AIS환인,량자골령일치.남성불전형측철적비례명현고우녀성환인(20.9％비10.0％,P＜0.01).재구유전형측철적환인중,불전형특정적분포무명현적성별차이；단여녀성AIS상비,남성AIS구유교고비례적단흉만(46.2％비33.8％,P＜0.01)급흉추과도후철(11.1％비2.0％,P＜0.01).재구유결구성흉만적전형측철중,남성환인적흉만Cobb각급흉추후철균교녀성환인대,흉만유인성교녀성소.결론 Cobb각≥40°적AIS환인적만형、측철Cobb각급유인성、흉추후철균존재성별차이.남성AIS환인중불전형측철적발병솔명현고우녀성환인.전형측철환인중,남성AIS단흉만진전적개솔가능교녀성환인고.남성AIS결구성측철교녀성환인강경가능여기지구치료화수술교형적효과교차유관；재구유결구성흉만적남성AIS환인중,흉추과도후철병불표명신경계통일정존재이상.
Objective To investigate the curve patterns and radiographic characteristics in male adolescents with idiopathic scoliosis (AIS) with Cobb angle more than 40°.Methods The medical records and preoperative radiographs of patients who had surgery for treatment of AIS between 2008and 2009,without any previous treatment for scoliosis,were retrospectively analyzed.The curve severity,flexibility,and thoracic kyphosis were analyzed on standing posteroanterior and lateral radiographs and side bending films.In addition,scoliosis curves were classified as typical or atypical in patterns and features for patient sub-group comparisons.Results 91 male and 260 female AIS patients were retrieved and both showed similar skeletal maturity.Atypical curves were more frequently observed in male patients (20.9％) than in female (10.0％) (P＜0.01).In patients with typical curve patterns,no gender difference was found in the distribution of atypical features.Males showed significantly higher incidence of major right thoracic curve,and greater frequency of hyperkyphosis than female patients.In patients who had typical curve patterns that included a major thoracic curve (single thoracic or double major curve patterns),male patients had larger magnitude of thoracic curve,more severe thoracic kyphosis,and more rigid thoracic and lumbar curves compared to female patients.Conclusions There are radiographic differences in the curve patterns,severity of scoliosis and kyphosis,and spinal flexibility between female and male AIS patients with Cobb angle more than 40.Atypical curve patterns were more predominant in male patients.In patients with typical curve patterns,the thoracic curve in male AIS might have higher risk of progression than that in female.The higher rigidity of both thoracic and lumbar curves in male AIS might contribute to the lower curve correction rate.In addition,male AIS patients with increased thoracic kyphosis may not have increased incidence of abnormal neural axis than in female.