青少年特发性脊柱侧凸与神经源性脊柱侧凸患者椎体和椎间盘的楔形变及其临床意义

Disc and vertebral wedging and their clinical significance in patients with adolescent idiopathic scoliosis and neurological scoliosis

目的:观察青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)与神经源性脊柱侧凸(neurological scoliosis,NS)患者的椎体和椎间盘的楔形变情况,探讨其临床意义。方法:对35例AIS患者和31例NS患者(继发于Chiari畸形)应用Cobb法测量胸椎和腰椎每个侧凸范围内顶椎及其上、下各两个椎体和相应椎间盘的楔变角,计算其占整个侧凸角度的百分比(楔变率),得出侧凸范围内5个椎体的平均楔变率和4个椎间盘的平均楔变率。应用SPSS10.0统计软件进行统计分析,组间比较采用单因素方差分析。结果:相同病因、相同侧凸部位、相同Cobb角分组情况下,椎体与椎间盘的楔变率存在显著性差异(P<0.05)。相同病因、相同侧凸部位,Cobb角<60°组的椎体楔变率和椎间盘楔变率与Cobb角≥60°组比较均无显著性差异(P>0.05)。相同侧凸部位、相同Cobb角分组,AIS组椎体和椎间盘的楔变率分别与NS组比较均无显著性差异(P>0.05)。结论:AIS与NS患者椎体与椎间盘的相对楔形变方式相同,AIS患者的椎体楔形变可能是继发的。在治疗脊柱侧凸时,即便是较小角度的脊柱侧凸,都应该考虑到其存在椎体和椎间盘的楔形变。

Objective：To investigate the disc and vertebral wedging and their clinical significance in patients with adolescent idiopathic scoliosis（AIS）and neurological scoliosis（NS）.Method：35 AIS and 31 NS cases（all secondary to Chiari-Deformity）were reviewed radiographically.The percentage of single disc and vertebral wedging in the whole thoracic or lumbar curve was measured by Cobb＇s method.The average wedging of 5 vertebrae and four discs was calculated which included apex and two superior and two inferior vertebrae as well as discs between these vertebrae.The statistical analysis was conducted using SPSS 10.0 software.The comparison between groups was done by single factor variance analysis.Result：The study showed statistical difference between disc and vertebral wedging with regarding to the same curve location,same etiology and same Cobb angle（P〈0.05）,while no significant difference with respect to either disc wedging or vertebral wedging was found between AIS and NS with regarding to ...更多the same curve and same Cobb angle（P〉0.05）.The significant difference of either the disc wedging or vertebral wedging was also not found between Cobb angle 〈60° and ≥60° with respect to the same curve and same etiology（P〉0.05）.Conclusion：The pattern of vertebrae and discs wedging is similar between AIS and NS.AIS may be secondary to some extravertebral factors.In the treatment of scoliosis,the present of vertebral and disc wedging should be considered even in a small curve.