青少年特发性脊柱侧弯胸腰椎生理曲度的影像学研究

Imaging study on thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis

目的:探讨青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)胸腰椎生理曲度变化情况以及不同类型侧弯之间胸腰椎生理曲度的差异。方法:自2017年1月至2021年12月回顾性分析305例脊柱全长正侧位X线片的青少年患者,根据有无侧弯分为正常组和侧弯组。正常组179例,男79例,女100例;年龄10~18(12.84±2.10)岁。侧弯组126例,男33例,女93例;年龄10~18(13.92±2.20)岁。观察并比较两组Risser征、胸椎后凸角(thoracic kyphosis,TK)与腰椎前凸角(lumbarlordosis,LL),并分析比较不同性别、不同程度侧弯与不同节段侧弯TK值与LL值。结果:侧弯组在女性比率(P=0.001)、年龄(P<0.001)方面均明显高于正常组;Risser征方面,正常组低级别骨化程度比率明显高于侧弯组(P=0.038)。侧弯组TK值明显小于正常组(P<0.001),而两组LL值比较,差异无统计学意义(P=0.147)。男性与女性之间比较,TK值与LL值差异无统计学意义。轻度侧弯TK值明显大于中度侧弯(P<0.05),但LL值比较,差异无统计学意义(P>0.05)。不同节段侧弯之间TK值与LL值比较,差异均无统计学意义(P>0.05)。结论:胸椎与腰椎生理曲度均与性别无关;AIS患者胸椎生理曲度变小,但是腰椎生理曲度基本不变。轻度AIS患者的胸椎生理曲度大于中度AIS患者,但是腰椎生理曲度在轻中度患者之间几乎无差异,且与正常青少年相似。AIS患者胸腰椎生理曲度变化可能与脊柱前柱相对生长过快有关,其具体机制有待进一步研究。

Objective To observe the alteration of thoracic and lumbar physiological curvature in adolescent idiopathic scoliosis(AIS)and the difference of physiological curvature between different types of scoliosis.Methods A retrospective analysis was conducted on 305 adolescent patients taken full spine X-ray in our hospital from January 2017 to December 2021.The patients were divided into normal group and scoliosis group.The normal group was composed of 179 patients,79 males and 100 females,aged 10 to 18 years old with an average of(12.84±2.10)years old,with cobb agle less than 10 degrees.The scoliosis group was composed of 126 patients,33 males and 93 females,aged 10 to 18 years old with an average of(13.92±2.20)years old.The gender,age,Risser sign,thoracic kyphosis(TK)and lumbar lordosis(LL)in 2 groups were compared,and the TK and LL were also compared between different genders,different degrees of scoliosis and different segments of scoliosis.Results The female ratio(P=0.001)and age(P<0.001)in scoliosis group were higher than them in normal group;the ratio of low-grade ossification was higher in normal group than in scoliosis group(P=0.038).TK was significantly smaller in scoliosis group than in normal group(P<0.001),but there was no significant difference in LL between the 2 groups(P=0.147).There were no significant difference in TK and LL between male and female.The TK was significantly bigger in mild AIS patients than in moderate AIS patients(P<0.05),but there was no significant difference in LL between mild and moderate patients(P>0.05).The TK and LL in different segments scoliosis were not found significant difference.Conclusion The physiological curvature of thoracic and lumbar spine is independent of gender.The thoracic physiological curvature becomes smaller in AIS patients,but lumbar curvature remains unchanged.The thoracic physiological curvature in mild AIS patients is greater than that in moderate AIS patients,but the lumbar curvature is almost unchanged between mild and moderate scoliosis and is similar with that in normal adolescent.The alteration of thoracic and lumbar physiological curvature in AIS patients may be related to relative anterior spinal overgrowth,and the specific detailed mechanism needs to be further studied.