脊柱侧凸矫形预测方法评价

Evaluation of radiographic methods for predicting scoliosis correction

目的分析比较站立位弯曲像、悬吊牵引像和支点弯曲像在脊柱侧凸矫形中的预测作用与价值。方法选择我院自1998年7月～2000年7月间的胸椎侧凸畸形患者27例;年龄11～35岁,平均16.4岁。全部病例均采用后路脊柱侧凸矫形植骨融合术,第三代节段性内固定系统固定。采用标准方法测量术前脊柱正侧位、站立位弯曲像、悬吊牵引像和支点弯曲像以及术后正位像的Cobb角,将所得结果进行统计学分析。结果(1)术后平均Cobb角为31°,较术前胸弯(平均Cobb角61°)改善明显(t=1.706,P<0.01),平均矫正率为51.6%;(2)三种检查方法都与术后胸弯Cobb角呈正相关(P<0.01);(3)支点弯曲像与术后Cobb角无差异(P>0.05),其它两种方法与术后Cobb角差异有非常显著性意义(P<0.01)。结论(1)支点弯曲像可以用于评价胸弯的柔韧度,其效果优于站立位侧方弯曲像和悬吊牵引像;(2)分析脊柱侧凸畸形需联合应用三种方法,并预测脊柱侧凸的矫形。

Objective To evaluate the standing bending, traction and fulcrum bending radiographies in the prediction of scoliosis correction. Methods 27 patients with thoracic scoliosis with an average of 16.4 years old were selected for the evaluation. All the patients were treated with the posterior correction and bone grafting fusion, and fixed with the third generation system of the segmental vertebral fixation, such as TSRH, CD, or CD+Horizon. Measurement of the Cobbs angle was carried out in the preoperative posterior anterior radiographies with the natural position, standing bending, traction and fulcrum bending and in the postoperative posterior anterior radiographies. Results Mean of Cobbs angle at the thoracic curve after operation was 31 degrees, which decreased significantly in comparison with the preoperative data. Average correction rate was 51.6%. The postoperative Cobbs angle at the thoracic curve was positively correlated with the preoperative Cobbs angle in the standing bending, traction and fulcrum bending radiographies. It was significantly different from the preoperative Cobbs angle in the standing bending and traction radiographies, while no difference was seen with the fulcrum bending radiography. Conclusion The fulcrum radiography can be used to evaluate the flexibility of the thoracic scoliosis, and is better than the standing bending and traction radiographies. The three methods should be used together for the analysis of the scoliosis to predict the result of the scoliosis correction.