仰卧支点加压位X线片预测青少年特发性脊柱侧凸患者矫形效果的价值

The significance of supine fulcrum pressurized radiograph for surgical correction results of adolescent idiopathic scoliosis

目的研究运用仰卧支点加压位X片评价青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)脊柱柔韧性和预测矫形效果的价值。方法AIS患者65例,根据站立位X线片Cobb角角度分为中度侧凸组和重度侧凸组。术前均拍摄脊柱全长站立位正位X线片、仰卧位左右侧屈位X线片、悬吊正位X线片、支点弯曲位X线片、仰卧位支点加压位X线片及术后站立位正位X线片。所有病例均采用TSRH内固定系统。测量每位患者各种体位X线片Cobb角角度。结果在两组中支点加压位X线片Cobb角大小与术前其他体位X线片Cobb角大小差异均有统计学意义(P<0.05),在中度侧凸组中支点加压位X线片与术后站立位X线片Cobb角大小相比差异无统计学意义,(P>0.05),并呈正相关(r=0.799),预测的矫正率与术后矫正率比较差异也无统计学意义,(P>0.05)。柔软性侧凸组中支点加压位发X线片与术后站立位X线片Cobb角大小相比较差异无统计学意义,(P>0.05),并呈正相关(r=0.682)。结论仰卧位支点加压位X线片能较为准确的评价AIS患者脊柱的柔韧性,预测柔软性侧凸患者术后的矫正率,并为手术方案的选择提供重要的参考依据。

Objective To research on using supine fulcrum pressurized radiograph to evaluate spinal flexibility and predict surgical correction effect in adolescent idiopathic seoliosis （AIS）. Methods Sixty-five patients with AIS were divided into 2 groups according to the Cobb ＇ s angles on standing position radiograph, the moderate curve group and the severe curve group. All the eases underwent preoperative X-rays for total spine in the position of anteroposterior standing, supine lateral bending, anteroposterior gravity-suspending traction, fulcrum bending, supine fulcrm pressurized and postoperative X-rays of anteroposterior standing position. All the cases underwent surgical treatment with TSRH fixation system. The Cobb＇ s angles were measured in different positions. Results For the 2 groups, there were some statistic differences between the mean Cobb＇ s angles on fulcrum pressurized radiograph and those on preoperative radiograph of other positions （P 〈 0.05 ）. In the moderate curve group, Cobb＇ s angles on fulcrum pressurized radiograph had no significant difference with those on postoperative standing position radiograph （P 〉 0.05） and showed positive correlation （ r =0. 799）. Curve flexibility provided by fulcrum pressurized radiograph had no significant difference with postoperative correction ratio （ P 〉 0.05 ）. In the flexible group, there was no sig, nificant difference between Cobb＇ s angles of fulcrum pressurized radiograph and that of postoperative standing position radiograph （ P 〉 0. 05 ）, and the correlation was positive （ r = 0. 682）. Conclusion The supine fulcrum pressurized radiograph can evaluate spinal flexibility accurately and predict postoperative deformity correction ratio in AIS, which provides important references to surgery programs.