中华解剖与临床杂志
中華解剖與臨床雜誌
중화해부여림상잡지
Chinese Journal of Anatomy and Clinics
2014年
5期
358-362
,共5页
鲍虹达%朱锋%邱勇%何守玉%闫鹏%周恒才%朱泽章%刘臻
鮑虹達%硃鋒%邱勇%何守玉%閆鵬%週恆纔%硃澤章%劉臻
포홍체%주봉%구용%하수옥%염붕%주항재%주택장%류진
青少年特发性脊柱侧凸%腰椎前凸%站立位%平卧位%矢状面
青少年特髮性脊柱側凸%腰椎前凸%站立位%平臥位%矢狀麵
청소년특발성척주측철%요추전철%참립위%평와위%시상면
Adolescent idiopathic scoliosis%Lumbar lordosis%Standing position%Supine position%Sagittal profile
目的 观察单胸弯青少年特发性脊柱侧凸(T-AIS)患者和单腰弯AIS (L-AIS)患者的腰椎前凸(LL)在平卧位下的改变,量化评估平卧位对LL的影响,并评估站立位冠状面腰弯是否影响平卧位LL的变化趋势.方法 回顾性分析2010年1月-2012年12月南京大学医学院附属鼓楼医院行手术治疗的女性AIS患者的临床资料,其中T-AIS 50例,L-AIS 44例.T-AIS患者的平均年龄为(14.95±2.82)岁,术前平均Cobb角为47.19°±10.43°;L-AIS患者的平均年龄(15.22±2.28)岁,术前平均Cobb角为48.12°±9.29°,两组患者的年龄及Cobb角的差异均无统计学意义(t=0.506、P=0.614及t=0.439、P=0.661).脊柱侧凸患者存在支具治疗史,神经肌源性疾病、内分泌紊乱、骨骼发育不良、神经系统异常、结缔组织病或智力异常均被排除.所有患者均在术前摄站立位全脊柱侧位X线片及平卧位腰椎侧位X线片.在站立位及平卧位侧位X线片上测量LL.采用Pearson相关性分析分别分析T-AIS和L-AIS患者站立位和平卧位LL的相关性;分别对T-AIS和L-AIS患者站立位和平卧位LL的差值(ΔLL)进行一般统计学分析,并使用独立样本t检验评估两组患者站立位LL、平卧位LL及ΔLL之间的差异.以P＜0.05为差异有统计学意义.结果 T-AIS患者的站立位LL为50.49°±8.73°,显著大于平卧位状态下的40.79°±9.89°(t=5.199,P＜0.01);L-AIS患者的站立位LL(51.95°±13.49°)和平卧位LL(36.37°±11.82°)的差异有统计学意义(t=5.762,P＜0.01).虽然两组患者间站立位LL的差异(t'=-0.614)和平卧位LL(t 1.974)的差异均无统计学意义(P值均＞0.05),但是L-AIS患者的ΔLL(9.70°±9.34°)大于T-AIS患者的ΔLL(15.58°±12.42°),差异有统计学意义(t=2.613,P=0.01l).Person相关性分析显示,T-AIS和L-AIS患者的站立位和平卧位LL均存在显著相关性(r分别为0.683和0.778,P值均＜0.01).T-AIS站立位LL的线性回归方程为(Y)站立位LL=25.913+0.602 X平卧位LL,L-AIS站立位LL的线性回归方程为(Y)站立位LL=19.779+0.888X平卧位LL.结论 在T-AIS和L-AIS患者中,平卧位LL和站立位LL均存在显著相关性,从站立位到平卧位的LL改变在腰弯侧凸患者体现的尤其明显.腰弯AIS患者的术中弯棒需要考虑平卧位和站立位LL角度的不同.
目的 觀察單胸彎青少年特髮性脊柱側凸(T-AIS)患者和單腰彎AIS (L-AIS)患者的腰椎前凸(LL)在平臥位下的改變,量化評估平臥位對LL的影響,併評估站立位冠狀麵腰彎是否影響平臥位LL的變化趨勢.方法 迴顧性分析2010年1月-2012年12月南京大學醫學院附屬鼓樓醫院行手術治療的女性AIS患者的臨床資料,其中T-AIS 50例,L-AIS 44例.T-AIS患者的平均年齡為(14.95±2.82)歲,術前平均Cobb角為47.19°±10.43°;L-AIS患者的平均年齡(15.22±2.28)歲,術前平均Cobb角為48.12°±9.29°,兩組患者的年齡及Cobb角的差異均無統計學意義(t=0.506、P=0.614及t=0.439、P=0.661).脊柱側凸患者存在支具治療史,神經肌源性疾病、內分泌紊亂、骨骼髮育不良、神經繫統異常、結締組織病或智力異常均被排除.所有患者均在術前攝站立位全脊柱側位X線片及平臥位腰椎側位X線片.在站立位及平臥位側位X線片上測量LL.採用Pearson相關性分析分彆分析T-AIS和L-AIS患者站立位和平臥位LL的相關性;分彆對T-AIS和L-AIS患者站立位和平臥位LL的差值(ΔLL)進行一般統計學分析,併使用獨立樣本t檢驗評估兩組患者站立位LL、平臥位LL及ΔLL之間的差異.以P＜0.05為差異有統計學意義.結果 T-AIS患者的站立位LL為50.49°±8.73°,顯著大于平臥位狀態下的40.79°±9.89°(t=5.199,P＜0.01);L-AIS患者的站立位LL(51.95°±13.49°)和平臥位LL(36.37°±11.82°)的差異有統計學意義(t=5.762,P＜0.01).雖然兩組患者間站立位LL的差異(t'=-0.614)和平臥位LL(t 1.974)的差異均無統計學意義(P值均＞0.05),但是L-AIS患者的ΔLL(9.70°±9.34°)大于T-AIS患者的ΔLL(15.58°±12.42°),差異有統計學意義(t=2.613,P=0.01l).Person相關性分析顯示,T-AIS和L-AIS患者的站立位和平臥位LL均存在顯著相關性(r分彆為0.683和0.778,P值均＜0.01).T-AIS站立位LL的線性迴歸方程為(Y)站立位LL=25.913+0.602 X平臥位LL,L-AIS站立位LL的線性迴歸方程為(Y)站立位LL=19.779+0.888X平臥位LL.結論 在T-AIS和L-AIS患者中,平臥位LL和站立位LL均存在顯著相關性,從站立位到平臥位的LL改變在腰彎側凸患者體現的尤其明顯.腰彎AIS患者的術中彎棒需要攷慮平臥位和站立位LL角度的不同.
목적 관찰단흉만청소년특발성척주측철(T-AIS)환자화단요만AIS (L-AIS)환자적요추전철(LL)재평와위하적개변,양화평고평와위대LL적영향,병평고참립위관상면요만시부영향평와위LL적변화추세.방법 회고성분석2010년1월-2012년12월남경대학의학원부속고루의원행수술치료적녀성AIS환자적림상자료,기중T-AIS 50례,L-AIS 44례.T-AIS환자적평균년령위(14.95±2.82)세,술전평균Cobb각위47.19°±10.43°;L-AIS환자적평균년령(15.22±2.28)세,술전평균Cobb각위48.12°±9.29°,량조환자적년령급Cobb각적차이균무통계학의의(t=0.506、P=0.614급t=0.439、P=0.661).척주측철환자존재지구치료사,신경기원성질병、내분비문란、골격발육불량、신경계통이상、결체조직병혹지력이상균피배제.소유환자균재술전섭참립위전척주측위X선편급평와위요추측위X선편.재참립위급평와위측위X선편상측량LL.채용Pearson상관성분석분별분석T-AIS화L-AIS환자참립위화평와위LL적상관성;분별대T-AIS화L-AIS환자참립위화평와위LL적차치(ΔLL)진행일반통계학분석,병사용독립양본t검험평고량조환자참립위LL、평와위LL급ΔLL지간적차이.이P＜0.05위차이유통계학의의.결과 T-AIS환자적참립위LL위50.49°±8.73°,현저대우평와위상태하적40.79°±9.89°(t=5.199,P＜0.01);L-AIS환자적참립위LL(51.95°±13.49°)화평와위LL(36.37°±11.82°)적차이유통계학의의(t=5.762,P＜0.01).수연량조환자간참립위LL적차이(t'=-0.614)화평와위LL(t 1.974)적차이균무통계학의의(P치균＞0.05),단시L-AIS환자적ΔLL(9.70°±9.34°)대우T-AIS환자적ΔLL(15.58°±12.42°),차이유통계학의의(t=2.613,P=0.01l).Person상관성분석현시,T-AIS화L-AIS환자적참립위화평와위LL균존재현저상관성(r분별위0.683화0.778,P치균＜0.01).T-AIS참립위LL적선성회귀방정위(Y)참립위LL=25.913+0.602 X평와위LL,L-AIS참립위LL적선성회귀방정위(Y)참립위LL=19.779+0.888X평와위LL.결론 재T-AIS화L-AIS환자중,평와위LL화참립위LL균존재현저상관성,종참립위도평와위적LL개변재요만측철환자체현적우기명현.요만AIS환자적술중만봉수요고필평와위화참립위LL각도적불동.
Objective To quantify the influence of supine position on lumbar lordosis and to evaluate whether lumbar curve would affect the change of lumbar lordosis from standing position to supine position.Methods Fifty female thoracic adolescent idiopathic scoliosis (T-AIS) patients and forty-four female lumbar adolescent idiopathic scoliosis (L-AIS) patients were collected in Spine Surgery of the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2010 to December 2012.The dataes of these patients were retrospectively reviewed in this study.The mean age of T-AIS patients was (14.95 ±2.82) years and the Cobb angle averaged 47.19° ± 10.43°.While in L-AIS patients,the age averaged (15.22 ±2.28) years and Cobb angle 48.12° ±9.29°.No difference was found in terms of age and Cobb angle (t =0.506,P =0.614,t =0.439,P =0.661).Patients with history of brace treatment neuromuscular disease,osteopenia,neurological disorders,endocrine disorders,connective tissue diseases or abnormal intelligence were excluded.The long-cassette standing radiographies and lumbar X-ray lateral films in supine position were obtained from all subjects.Lumbar lordosis (LL) was measured on both standing and supine films.The relationship between standing LL and supine LL was calculated by Pearson correlation in both T-AIS and L-AIS groups.The differences in terms of standing LL,supine LL and ΔLL were also analyzed through independent t test.Statistically significant differences were defined by P ＜ 0.05.Results The standing LL averaged in T-AIS group,which was significantly larger than supine LL in the same group (50.49° ± 8.73° vs.40.79° ± 9.89°,t =5.199,P ＜ 0.01).Similarly,significant difference was also observed in L-AIS group (51.95°±13.49° vs.36.37° ±11.82°,t=5.762,P＜0.01).According to Pearson correlation,strong correlations were observed between standing LL and supine LL in both T-AIS and L-AIS groups(r =0.683,r =0.778,all P values ＜ 0.01).The regression formula of standing LL in T-AIS group was (Y)standing LL =25.913 +0.602 Xsupine LL ; while the formula in L-AIS group was (Y)standing LL =19.779 + 0.888 Xsupine LL.Conclusions In both T-AIS and L-AIS groups,strong correlations can be found between standing LL and supine LL.The change of LL is more obvious in L-AIS patients.The difference between standing and supine LL should be considered in surgery of L-AIS patients.
