不同类型少儿型特发性脊柱侧凸患者站立位及步行中骨盆冠状面倾斜程度分析

Analysis of Pelvic Obliquity in Standing Position and during Walking in Patients with Different Types of Juvenile Idiopathic Scoliosis

目的 评估不同类型少儿型特发性脊柱侧凸(juvenile idiopathic scoliosis, JIS)患者站立位及步行中骨盆冠状面倾斜程度的差异。方法 回顾性纳入2020年9月—2022年12月北京协和医院JIS患者(存在脊柱侧凸且Cobb角≥10°)及同期非JIS患者(存在脊柱侧凸但Cobb角<10°)。根据站立时正位全脊柱X线片侧凸情况,将JIS患者分为存在腰椎/胸腰椎侧凸组(A组),不存在腰椎/胸腰椎侧凸组(B组)。以双侧髂嵴作为骨盆冠状面的骨性标志点,测量站立位及步行周期中双侧髂嵴高度及其变化值,以评估不同类型JIS患者骨盆冠状面倾斜程度。结果 共入选符合纳入与排除标准的JIS患者73例(A组54例,B组19例),非JIS患者34例。A组站立位髂嵴较高侧与脊柱凸侧之间关系“合理”(腰椎/胸腰椎凸侧的髂嵴低于凹侧)的比例为61.1%(33/54),非JIS患者站立位髂嵴较高侧与脊柱凸侧之间关系“合理”(双侧髂嵴等高)的比例为38.2%(13/34),二者差异具有统计学意义(P=0.036)。B组“合理”的比例与非JIS患者无显著差异(26.3%比38.2%,P=0.380)。A组在整个步态周期中(包括支撑相最小值、支撑相最大值、摆动相最小值及摆动相最大值)双侧髂嵴高度变化值均具有统计学差异(P均<0.05),且腰椎凸侧的髂嵴高度变化值明显高于凹侧(P均<0.05),而非JIS患者和B组JIS患者在整个步态周期中双侧髂嵴高度变化值均无统计学差异(P均>0.05)。结论 存在腰椎/胸腰椎侧凸的JIS患者站立位脊椎凸侧的髂嵴高度低于凹侧,在步行中依靠增大凸侧骨盆冠状面倾斜程度以维持身体双侧平衡。

Objective To analyze the correlation between juvenile idiopathic scoliosis(JIS)with lumbar and thoracic scoliosis and the degree of pelvis obliquity in standing position and during walking.Methods The patients with JIS(Cobb≥10°)admitted into Peking Union Medical College Hospital from Sep-tember 2020 to December 2022 and non-JIS patients(Cobb<10°)during the same period were retrospectively in-cluded.According to the results of anteroposterior X-ray of the whole spine in the standing position,JIS patients were divided into a group with lumbar/thoracolumbar scoliosis(group A)and a group without lumbar/thoraco-lumbar scoliosis(group B).The change value of the bilateral iliac crest height,used as osseous landmarks,was measured in standing position and during walking.Bilateral iliac crest heights and their change values were meas-ured in standing position and during the walking cycle to analyze the degree of pelvic coronal tilt in patients with different types of JIS.Results A total of 73 JIS patients(54 patients in group A,and 19 patients in group B)and 34 non-JIS patients who met the inclusion and exclusion criteria were enrolled.In group A,611%(33/54)of patients showed a“reasonable”relationship between the higher side of the iliac ridge and the convex side of the spine(the iliac ridge of the convex side of the lumbar spine/thoracolumbar spine was lower than that of the concave side),and 382%(13/34)of non-JIS patients showed a“reasonable”relationship between the higher side of the iliac ridge and the convex side of the spine(the iliac ridge of the convex side of the lumbar spine/tho-racolumbar spine was at the same height as that of the concave side).The difference was statistically significant(P=0036).The proportion of“reasonable”relationship in group B was not significantly different from that in non-JIS patients(263%vs 382%,P=0380).In group A,there were statistically significant differences in iliac crest height changes on both sides during the whole gait cycle(including minimum,maximum,minimum and maximum of the supporting phase)(all P<005),and the iliac crest height changes on the convex side of lumbar spine were significantly higher than those on the concave side(all P<005).However,there was no sig-nificant difference in bilateral iliac crest height between non-JIS patients and JIS patients in group B during the whole gait cycle(all P>005).Conclusion In JIS patients with lumbar or thoracolumbar scoliosis,the iliac crest height of the lumbar scoliosis was lower than that of the concave side in standing position,and therefore,the tilt degree of pelvis obliquity should be increased to maintain bilateral balance during walking.