仰卧支点加压侧屈位片评估青少年特发性脊柱侧凸脊柱柔韧性的价值

Evaluation of supine fulcrum pressurized radiograph for predicting spinal flexibility in adolescent idiopathic scoliosis

目的 探讨仰卧支点加压侧屈位片评估青少年特发性脊柱侧凸（AIS）患者脊柱柔韧性的价值.方法 （1）实验研究：在同侧2个支点A-B与对侧1个支点C之间放置塑杆作压力测试,支点C位于支点A-B的中点时对塑杆加压,测量支点C加压后塑杆A侧端投影的移位数;A-C距离加倍时重复前一次的加压试验.分析加长力距对降低压力强度产生的影响.（2）临床研究：45例（男16例,女29例）AIS患儿术前检查包括全脊柱站立位正位X线平片、支点侧屈位和卧位侧屈位片,测量脊柱侧凸Cobb角,并计算带结构性弯曲的主弯柔韧性.结果 （1）支点A-C距离为25 cm,在支点C加压,压力定量刻度数分别在测量尺的1和2格时,塑杆投影移位分别为5 cm和10 cm;支点A-C距离为50 cm,在支点C加压,压力定量刻度数分别在测量尺的1和2格时,塑杆投影移位分别为8 cm和15 cm;加压支点间距越长,使塑杆投影移位的力越小.（2）45例患儿的卧位侧屈位与支点加压侧屈位片比较：男性组Cobb角分别为28.6°±4.4°、16.70°±4.6°,柔韧性分别为47.6%±8.1%、69.4%±8.5%;女性组Cobb角分别为24.5°±2.7°、12.6°±2.4°,柔韧性分别为53.4%±5.2%、76.0%±4.7%,差异均有统计学意义（P值均＜0.01）,且AIS患儿的脊柱主弯的柔韧性女性高于男性.结论 仰卧位支点加压技术可弥补仰卧侧屈位片主动矫形力的不足,是一种简便、安全、能准确地评价侧凸脊柱柔韧性的方法.

Objective To examine supine fulcrum pressurized radiograph to predict spinal flexibility in adolescent idiopathic scoliosis （AIS）. Methods 1. Empirical study： put two points （A and B） on one side of the plastic stick and one point on the other side （ C）, pressurize on the plastic stick when point C is in the middle of A and B, and then measure the projection shifting of point A. Repeat the pressure test when the distance between A and C doubled. Analyze the effect of increasing distance on diminishing pressure. 2.Clinical study ：45 patients （ 16 males and 29 females） underwent standing anteroposterior radiograph ,fulcrum lateral flexion radiograph, supine lateral flexion radiograph. The Cobb＇s angles were measured and the flexibility ratio was determined on preoperative fulcrum radiograph. Results （1） If the length of A and C was 25 cm, pressurize on point C, when pressure quantitative scale number located 1 scale and 2 scale of the rule, projection shifting of point A were 5 cm and 10 cm. If the length of A and C was 50 cm, pressurize on point C, when pressure quantitative scale number located 1 scale and 2 scale of the rule, projection shifting of point A were 8 cm and 15 cm. The longer the distance, the lesser the pressure force of plastics stick. （2）The Cobb angles and curve flexibility provided by fulcrum lateral flexion radiograph had significant difference from that provided by supine lateral flexion radiograph in male group and female group. Cobb angles of male group was 28. 6°± 4. 1 °, 16. 7°± 4. 6° respectively （t= 7. 438, P ＜ 0. 01 ）and curve flexibility was 47. 6% ±8. 1% ,69. 4% ± 8. 5% respectively（ t = 7. 438, P ＜ 0. 01 ）. Cobb angles of female group was 24.5°± 2. 7°,12. 6°±2. 4° respectively（t = 17. 540,P ＜0. 01 ）and curve flexibility was 53.4% ±5.2% ,76. 0% ±4. 7% respectively（t = 17. 54, P ＜ 0. 01 ）. The flexibility of spinal main curve of female patients was obviously higher than male patients. Conclusions Supine fulcrum pressurized technique can make up for the insufficiency of supine lateral flexion technique, and provide a convenient, safe, precise and useful method for evaluation of spinal flexibility in AIS.