Fulcrum像评价青少年特发性脊柱侧凸柔韧性和预测矫形的意义

Evaluation of fulcrum bending radiograph for predicting curve flexibility and surgical correction result of adolescent idiopathic scoliosis

[目的]前瞻性研究术前支点弯曲（fulcrum）像评价青少年特发性脊柱侧凸（AIS）柔韧性和预测手术矫形效果的价值。[方法]根据入选和排除标准选择2003年10月~2006年8月的AIS患者64例,病例均为单弯（PUMCⅠa/Ⅰb/Ⅰc型）,根据术前站立正位X像Cobb’s角大小分为4组：中度胸弯组（20例,40°60°）、中度腰弯组（17例,35°60°）。各组按PUMC原则接受相同手术方法,均采用第3代节段性内固定系统。测量术前站立全脊柱正位像、fulcrum像及术后正位像的Cobb’s角,分析fulcrum像和术后正位像Cobb’s角的相关性并计算出fulcrum像侧凸柔韧性和术后侧凸矫正率,所得结果进行统计学分析。[结果]除中度胸弯组fulcrum像柔韧性和手术矫正率相比无显著差异（P=0.141）外,其余组均差异显著;中度胸弯组术后正位像和fulcrum像的Cobb’s角相比无显著差异（P=0.094）,其余组均差异显著;术后正位像和fulcrum像的Cobb’s角呈正相关,但中度腰弯组相关性一般（r=0.525）。[结论]Fulcrum只能评价和预测中度胸弯的柔韧性和术后矫正率,现代内固定器械发展尤其是全椎弓根螺钉的应用可获得更好的侧凸矫正率。

[Objective]A prospective comparative evaluation of fulcrum bending radiographs（fulcrum）to determine curve flexibility and predict surgical correction in adolescent idiopathic scoliosis（AIS）.[Method]A total of 64 consecutive patients with AlS according to inclusion and exclusion criterias who underwent surgical treatment were studied.All curve types were single-curve and the PUMC classification were Ia/Ib/Ic.All patients were divided into 4 groups according to the magnitude of Cobbs angle in preoperative standing anteroposterior radiograph：moderate thoracic curve（20 cases,40°60°）,moderate lumbar curve（21cases,35°60°）.The Cobbs angles were measured and the flexibility ratio was determined on fulcrum radiograph.The amount of correction obtained by fulcrum radiograph was compared with the amount of surgical correction by evaluating the differences from surgery as absolute values.The correlation of Cobbs angles between postoperative standing anteroposterior radiograph and fulcrum radiograph were analyzed.[Result]For the moderate thoracic curves,curve flexibility provided by fulcrum radiograph has no significant difference（P=0.141）from surgical curve correction,there was no significant difference（P=0.094）between the mean Cobbs angle on fulcrum bending and that on postoperative standing anteroposterior radiograph.The postoperative Cobbs angle was positively correlated with the preoperative Cobbs angle on fulcrum radiograph and the correlation degree in the moderate lumbar curve was relatively weak.[Conclusion]Fulcrum radiograph can only be used to assess the flexibility and correction of moderate thoracic curves in AIS.Pedicle screw instrumentation provides even more correction.