青少年特发性脊柱侧凸Cobb角度与躯干旋转角度及体重指数的相关性

Correlation of Cobb angle with angle of trunk rotation and body mass index in adolescent idiopathic scoliosiss

目的:分析青少年特发性脊柱侧凸(AIS)患者的Cobb角与躯干旋转角度(ATR)及体重指数(BMI)的相关性。方法:回顾性收集并分析2018年12月至2019年11月确诊的AIS患者的临床资料。根据PUMC分型将患者按主弯部位分型,采用Spearman相关性分析各分型患者Cobb角度与ATR及BMI的相关性。根据2016 SOSORT指南将患者按严重程度分级,利用χ^(2)检验比较各分级患者ATR<5°的比例差异。参照国家学生体质健康数据,采用单样本秩和检验比较各年龄段患者与同龄人群BMI的差异。结果:共纳入符合纳入和排除标准的240例AIS患者,Cobb角度与ATR呈显著正相关(r_(s)=0.621,P<0.001),与BMI无线性相关。根据PUMC分型进行主弯部位分型后,Cobb角度与BMI均无线性相关,Cobb角度与ATR在胸弯(r_(s)=0.624,P<0.001)、胸腰弯(r_(s)=0.488,P<0.001)、腰弯(r_(s)=0.632,P<0.001)均呈显著正相关,在上胸弯无线性相关;按2016 SOSORT指南进行严重程度分级后,轻度组中ATR<5°的比例为56.04%,各组间差异有统计学意义(P<0.001);各年龄段患者的BMI与同龄人群BMI无统计学差异。结论:ATR的大小可以反映Cobb角的大小,对于轻度AIS患者而言,采用scoliometer测量方法出现假阴性的风险较高,AIS患者的BMI无特殊临床意义。

Objective:To investigate the correlation of Cobb angle with angle of trunk rotation(ATR)and body mass index(BMI)in adolescent idiopathic scoliosis(AIS).Methods:Retrospective analysis of clinical data of AIS patients admitted from December 2018 to November 2019,collection and analysis of their clinical data.Patients were stratified based on their AIS subtype as per PUMC classification,and the correlation of Cobb angle with ATR and BMI in patients of each subtype was analyzed using Spearman correlation.The severity of AIS was also determined according to the 2016 International Society on Scoliosis Orthopaedic and Rehabilitation Treatment(SOSORT)guidelines,and the proportion of patients with ATR<5°was compared across different severity subgroups using chi-square test.With the external control of the national student physical health data,the differences in BMI between patients and students of the same age were compared using Wilcoxon signed-rank test.Results:A total of 240 patients with AIS who met the inclusion and exclusion criteria were enrolled in this study.Cobb angle was positively correlated with ATR(r_(s)=0.621,P<0.001),but not correlated with BMI.Subgroup analysis showed that Cobb angle was not linearly correlated with BMI regardless of AIS subtypes.Cobb angle was positively correlated with ATR in the thoracic curve group(r_(s)=0.624,P<0.001),thoracolumbar curve group(r_(s)=0.488,P<0.001),and lumbar curve group(r_(s)=0.632,P<0.001),but not in the upper thoracic curve group.The proportion of patients with ATR<5°was 56.04%in the group with mild disease as defined according to 2016 SOSORT guideline,which was significantly different compared with the moderate and severe groups(P<0.001).There was no significant difference in BMI of patients and controls of the same age.Conclusions:ATR is positively correlated with Cobb angle,and there is higher risk of false negative results with the scoliometer measurements in patients with mild AIS.BMI of AIS patients has no clinical relevance.