青少年特发性脊柱侧弯患者影像学锁骨水平的临床意义

Clinical value of radiographic clavicle balance for adolescent idiopathic scoliosis patients

目的评估青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)患者肩部影像学锁骨水平的临床意义。方法选取2010年6月-2011年12月在我院接受治疗的连续120例主胸弯AIS患者,取自然站立位脊柱全长后前位X线片及背部外观照,分别量取锁骨水平参数(包括锁骨角、锁骨差)和外观肩高。将锁骨水平参数与外观肩高分别进行相关分析及参数间差值比较,并应用受试者工作特征曲线(ROC曲线)对锁骨水平参数进行肩部平衡诊断价值的评估。结果锁骨差与外观肩高相关,r=0.86(P<0.05);锁骨角与外观肩高相关,r=0.73(P<0.05);10%患者锁骨差与外观肩高存在差别;应用锁骨角和锁骨差进行肩部平衡诊断的ROC曲线下面积(area under curve,AUC)均<0.9,提示不具有较高的诊断价值。结论锁骨水平与外观肩高显著相关,但不能准确反映患者肩部平衡情况,医师需通过其他资料全面了解患者肩部畸形情况。

Objective To assess the clinical value of radiographic clavicle balance for adolescent idiopathic scoliosis （AIS） patients. Methods One hundred and twenty AIS patients with a main thoracic curve admitted to our hospital from June 2010 to December 2011 were included in this study. The patients underwent spinal radiographs and shoulder aesthetic photographs at a natural standing position. Clavicle balance （clavicle angle and difference） parameters and shoulder height were analyzed by correlation analysis and differences between the parameters were compared. The value of clavicle balance parameters for diagnosis of shoulder balance was assessed according to the ROC curve. Results The clavicle difference was closely correlated with the shoulder height（P 〈 0.05）. Although a difference was found between clavicle balance and shoulder height, the area under the ROC curve was 〈 0.9, indicating that the value of clavicle angle and difference was not high for the diagnosis of clavicle balance. Conclusion Although the clavicle balance is significantly correlated with shoulder height, it cannot accurately predict the clavicle balance, thus physicians ne ed to have an overall understanding of should deformity through other parameters.