目的 评价长海支点侧屈位X线片在青少年特发性脊柱侧凸患者术前柔韧性评估中的作用和价值.方法 2012年6月至201 3年8月采用自行研制的可升降可测重长海支点侧屈位装置对37例青少年特发性脊柱侧凸患者的46个胸椎及腰椎侧弯进行术前影像学柔韧性评估,其中女性31例,男性6例;年龄10 ～ 19岁,平均15.0岁 评估内容包括术前站立前后位X线片、长海支点侧屈位X线片(基础支点侧屈位、最大支点侧屈位)、仰卧侧屈位X线片、传统支点侧屈位X线片以及术后1周站立前后位X线片.测量患者Cobb角并计算手术矫正率、侧弯柔韧性指数以及矫正指数.并测量长海最大支点高度、长海基础重量值和长海最大重量值.对术前几种评估方法的结果与术后矫形结果之间差异采用成对t检验,长海支点侧屈位柔韧性指数与手术矫正率、长海最大支点高度与长海最大重量、长海支点侧屈位支点高度变化与支点重量变化之间的相关性采用Pearson相关性及回归分析进行检验.结果 本组共包括46个结构性弯曲,其中28个主胸弯,1 8个胸腰弯/腰弯.46个被评估结构性弯曲在站立前后位X线片的术前平均Cobb角为47°±11°,术后1周平均Cobb角为1 1°±5°.仰卧侧屈位Cobb角(t=7.2,P=0.001)、传统支点侧屈位Cobb角(t=7.1,P=0.001)、长海基础支点侧屈位Cobb角(t=6.5,P=0.001)与术后站立前后位Cobb角相比差异有统计学意义;传统支点侧屈位Cobb角(t=11.0,P=0.001)、长海基础支点侧屈位Cobb角(t=13.6,P=0.001)与长海最大支点侧屈位Cobb角相比差异有统计学意义;而传统支点侧屈位Cobb角与长海基础支点侧屈位Cobb角相比差异无统计学意义(t=2.0,P =0.051),长海最大支点侧屈位Cobb角与术后站立前后位Cobb角相比差异无统计学意义(t=0.9,P=0.36) 长海最大支点高度平均为(29.6±1.4)cm,长海基础重量平均为(20±6)kg,长海最大重量值平均为(40 ±6)kg 28个主胸弯术前站立前后位Cobb角平均46°±1 1°,术后1周Cobb角平均12°±6°.18个胸腰弯/腰弯术前站立前后位Cobb角平均49°±12°,术后1周Cobb角平均10°±5°.两种侧弯的评估结果与整体数据评估结果一致.整体数据的相关性分析提示长海基础支点侧屈位柔韧性指数与手术矫正率呈正相关关系(r =0.67,r2=0.45,P =0.001),长海最大支点侧屈位柔韧性指数与手术矫正率也呈正相关关系(r=0.59,r2=0.35,P =0.001),长海最大支点侧屈位支点高度与支点上所测的最大重量呈正相关关系(r=0.69,r2=0.47,P=0.001),长海支点侧屈位支点高度变化与支点重量变化呈正相关关系(r=0.62,r2=0.38,P=0.001).结论 长海支点侧屈位X线片可以更好地反映青少年特发性脊柱侧凸患者的柔韧性,因此可以辅助脊柱侧凸患者的术前柔韧性评估.与传统的支点侧屈位X线片及仰卧侧屈位X线片相比,长海最大支点侧屈位X线片的结果更接近椎弓根螺钉系统矫形的结果.
目的 評價長海支點側屈位X線片在青少年特髮性脊柱側凸患者術前柔韌性評估中的作用和價值.方法 2012年6月至201 3年8月採用自行研製的可升降可測重長海支點側屈位裝置對37例青少年特髮性脊柱側凸患者的46箇胸椎及腰椎側彎進行術前影像學柔韌性評估,其中女性31例,男性6例;年齡10 ～ 19歲,平均15.0歲 評估內容包括術前站立前後位X線片、長海支點側屈位X線片(基礎支點側屈位、最大支點側屈位)、仰臥側屈位X線片、傳統支點側屈位X線片以及術後1週站立前後位X線片.測量患者Cobb角併計算手術矯正率、側彎柔韌性指數以及矯正指數.併測量長海最大支點高度、長海基礎重量值和長海最大重量值.對術前幾種評估方法的結果與術後矯形結果之間差異採用成對t檢驗,長海支點側屈位柔韌性指數與手術矯正率、長海最大支點高度與長海最大重量、長海支點側屈位支點高度變化與支點重量變化之間的相關性採用Pearson相關性及迴歸分析進行檢驗.結果 本組共包括46箇結構性彎麯,其中28箇主胸彎,1 8箇胸腰彎/腰彎.46箇被評估結構性彎麯在站立前後位X線片的術前平均Cobb角為47°±11°,術後1週平均Cobb角為1 1°±5°.仰臥側屈位Cobb角(t=7.2,P=0.001)、傳統支點側屈位Cobb角(t=7.1,P=0.001)、長海基礎支點側屈位Cobb角(t=6.5,P=0.001)與術後站立前後位Cobb角相比差異有統計學意義;傳統支點側屈位Cobb角(t=11.0,P=0.001)、長海基礎支點側屈位Cobb角(t=13.6,P=0.001)與長海最大支點側屈位Cobb角相比差異有統計學意義;而傳統支點側屈位Cobb角與長海基礎支點側屈位Cobb角相比差異無統計學意義(t=2.0,P =0.051),長海最大支點側屈位Cobb角與術後站立前後位Cobb角相比差異無統計學意義(t=0.9,P=0.36) 長海最大支點高度平均為(29.6±1.4)cm,長海基礎重量平均為(20±6)kg,長海最大重量值平均為(40 ±6)kg 28箇主胸彎術前站立前後位Cobb角平均46°±1 1°,術後1週Cobb角平均12°±6°.18箇胸腰彎/腰彎術前站立前後位Cobb角平均49°±12°,術後1週Cobb角平均10°±5°.兩種側彎的評估結果與整體數據評估結果一緻.整體數據的相關性分析提示長海基礎支點側屈位柔韌性指數與手術矯正率呈正相關關繫(r =0.67,r2=0.45,P =0.001),長海最大支點側屈位柔韌性指數與手術矯正率也呈正相關關繫(r=0.59,r2=0.35,P =0.001),長海最大支點側屈位支點高度與支點上所測的最大重量呈正相關關繫(r=0.69,r2=0.47,P=0.001),長海支點側屈位支點高度變化與支點重量變化呈正相關關繫(r=0.62,r2=0.38,P=0.001).結論 長海支點側屈位X線片可以更好地反映青少年特髮性脊柱側凸患者的柔韌性,因此可以輔助脊柱側凸患者的術前柔韌性評估.與傳統的支點側屈位X線片及仰臥側屈位X線片相比,長海最大支點側屈位X線片的結果更接近椎弓根螺釘繫統矯形的結果.
목적 평개장해지점측굴위X선편재청소년특발성척주측철환자술전유인성평고중적작용화개치.방법 2012년6월지201 3년8월채용자행연제적가승강가측중장해지점측굴위장치대37례청소년특발성척주측철환자적46개흉추급요추측만진행술전영상학유인성평고,기중녀성31례,남성6례;년령10 ～ 19세,평균15.0세 평고내용포괄술전참립전후위X선편、장해지점측굴위X선편(기출지점측굴위、최대지점측굴위)、앙와측굴위X선편、전통지점측굴위X선편이급술후1주참립전후위X선편.측량환자Cobb각병계산수술교정솔、측만유인성지수이급교정지수.병측량장해최대지점고도、장해기출중량치화장해최대중량치.대술전궤충평고방법적결과여술후교형결과지간차이채용성대t검험,장해지점측굴위유인성지수여수술교정솔、장해최대지점고도여장해최대중량、장해지점측굴위지점고도변화여지점중량변화지간적상관성채용Pearson상관성급회귀분석진행검험.결과 본조공포괄46개결구성만곡,기중28개주흉만,1 8개흉요만/요만.46개피평고결구성만곡재참립전후위X선편적술전평균Cobb각위47°±11°,술후1주평균Cobb각위1 1°±5°.앙와측굴위Cobb각(t=7.2,P=0.001)、전통지점측굴위Cobb각(t=7.1,P=0.001)、장해기출지점측굴위Cobb각(t=6.5,P=0.001)여술후참립전후위Cobb각상비차이유통계학의의;전통지점측굴위Cobb각(t=11.0,P=0.001)、장해기출지점측굴위Cobb각(t=13.6,P=0.001)여장해최대지점측굴위Cobb각상비차이유통계학의의;이전통지점측굴위Cobb각여장해기출지점측굴위Cobb각상비차이무통계학의의(t=2.0,P =0.051),장해최대지점측굴위Cobb각여술후참립전후위Cobb각상비차이무통계학의의(t=0.9,P=0.36) 장해최대지점고도평균위(29.6±1.4)cm,장해기출중량평균위(20±6)kg,장해최대중량치평균위(40 ±6)kg 28개주흉만술전참립전후위Cobb각평균46°±1 1°,술후1주Cobb각평균12°±6°.18개흉요만/요만술전참립전후위Cobb각평균49°±12°,술후1주Cobb각평균10°±5°.량충측만적평고결과여정체수거평고결과일치.정체수거적상관성분석제시장해기출지점측굴위유인성지수여수술교정솔정정상관관계(r =0.67,r2=0.45,P =0.001),장해최대지점측굴위유인성지수여수술교정솔야정정상관관계(r=0.59,r2=0.35,P =0.001),장해최대지점측굴위지점고도여지점상소측적최대중량정정상관관계(r=0.69,r2=0.47,P=0.001),장해지점측굴위지점고도변화여지점중량변화정정상관관계(r=0.62,r2=0.38,P=0.001).결론 장해지점측굴위X선편가이경호지반영청소년특발성척주측철환자적유인성,인차가이보조척주측철환자적술전유인성평고.여전통적지점측굴위X선편급앙와측굴위X선편상비,장해최대지점측굴위X선편적결과경접근추궁근라정계통교형적결과.
Objective To evaluate the role and value of Changhai fulcrum bending radiograph (CH-FBR) in curve flexibility assessment of adolescent idiopathic scoliosis (AIS) patients.Methods Thirty-seven AIS patients treated between June 2012 and August 2013 were enrolled,including 31 female and 6 male patients whose age ranged from 10 to 19 years,averaged of 15.0 years.The assessment of radiographs included preoperative standing posterior-anterior radiograph,supine side-bending radiograph,traditional fulcrum bending radiograph,Changhai fulcrum bending radiograph and postoperative standing posterior-anterior radiograph.Postoperatively,radiographs were assessed at one week.The CH-FBR was performed at the lowest height and the optimized height which means the weight on the fulcrum touch the maximum.All measurements of angle were made with use of the Cobb method.The flexibility of the curve as well as the correction rate and fulcrum bending correction index (FBCI) were calculated for all patients.Themaximum height of CH-FBR,basic weight and maximum weight were measured for all AIS.Paired t-tests were used to assess differences between preoperative and postoperative curves within group samples.The Pearson correlation coefficients were calculated using bivariate analysis between CH-FBR flexibility rate and correction rate,the maximum height of CH-FBR and maximum weight,the height changes of CH-FBR and weight changes.Results A total of 46 curves were involved in this study,including 28 thoracic and 18 thoracolumbar/lunbar curves.Preoperatively,the mean Cobb angle of the 46 structural curves was 47° ± 11°.Postoperatively,the mean Cobb angle was 11° ±5°.Cobb's angle in supine side-bending(t =7.2,P =0.001),traditional fulcrum bending (t =7.1,P =0.001) and lowest height of Changhai fulcrum bending (t=6.5,P =0.001) were significantly different from the postoperative Cobb angle; Cobb's angle in traditional FBR (t =11.0,P =0.001) and lowest height of Changhai fulcrum bending (t =13.6,P =0.001) were significantly different from the optimized height CH-FBR Cobb angle.There was no significant difference found between traditional FBR Cobb angle and lowest height CH-FBR Cobb angle (t =2.0,P =0.051),optimized height CH-FBR Cobb angle and postoperative Cobb angle(t =0.9,P =0.36),lowest height CH-FBR Cobb angle and traditional FBR Cobb angle(t =2.0,P =0.051).The maximum height of CH-FBR,basic weight and maximum weight were (29.6 ± 1.4)cm,(20 ±6)kg,and(40 ±6)kg.Preoperatively,the mean Cobb angle of the 28 structural curves (main thoracic curves) was 46° ± 11°.Postoperatively,the mean Cobb angle was 12° ± 6°.Preoperatively,the mean Cobb angle of the 18 structural curves(thoracolumbar/lunbar curves) was 49° ± 12°.Postoperatively,the mean Cobb angle was 10° ± 5°.The results were same in 28 structural curves,18 structural curves as well as 46 curves.Correlation analysis of 46 curves indicated that the maximum height of CH-FBR positively correlated with maximum weight (r =0.69,2r =0.47,P =0.001),the height changes of CH-FBR positively correlated with weight changes on CH-FBR (r =0.62,r2 =0.38,P =0.001).Conclusions CH-FBR is a more reliable and effective method than traditional FBR and supine side-bending for curve flexibility evaluation in AIS patients.Moreover,compared to the traditional FBR and side-bending radiograph,the flexibility suggested by the optimized height CH-FBR more closely approximates the postoperative result made by pedicle screws fixation and fusion.
