贵阳市青少年特发性脊柱侧凸的流行病学调查研究

Epidemiological investigation study of adolescent idiopathic scoliosis in Guiyang City

目的调查贵阳市青少年特发性脊柱侧凸(AIS)的流行病学特点。方法采用整群抽样的方式选取符合标准的贵阳市10~15岁青少年作为调查对象。先采用目测法、Adams前屈试验法进行筛查,发现异常时使用脊柱侧凸测量尺进行测量,当读数≥5°提示阳性,则建议受检者进行全脊柱X线检查,并测量Cobb角。以站立正位全脊柱X线片上测量Cobb角≥10°为AIS的诊断标准。统计和分析调查对象年龄、性别、体重指数(BMI)、腰臀比等基本情况,并总结AIS患者的弯曲类型及位置分布,以及AIS患者在不同Cobb角范围的分布情况。结果本研究共有14005例青少年完成了调查,共筛查发现AIS患者354例,患病率为2.5%(354/14005),其中男108例,女246例,患病率分别为0.8%、1.8%;男女之间的Cobb角比较,差异不显著(P>0.05);男女之间的腰臀比有显著差异(P<0.05)。在354例AIS患者中,265例(74.9%)为单向弯曲,83例(23.4%)为双向弯曲,6例(1.7%)为三向弯曲。在单向弯曲青少年中,最常见的脊柱侧凸位置是腰椎段。90.5%的AIS患者的Cobb角在10°~19°,大角度弯曲在女孩中更为常见。结论贵阳市青少年AIS的患病率为2.5%,这一患病率位于我国既往文献研究报告的总体发病率2%~3%之间,也与其他国家报告的患病率相似。建议未来进行更大范围的AIS筛查,同时开展对校医的规范化培训,以便更好地做好筛查工作。

Objective To investigate the epidemiological characteristics of adolescent idiopathic scoliosis(AIS)in Guiyang City.Methods Cluster sampling was used to select 10-15 year-old adolescents in Guiyang who met the criteria as the survey subjects.First,the visual method and Adams forward flexion test were used for screening.When abnormalities were found,the scoliosis measuring ruler was used for measurement.A reading of≥5°indicated a positive result,and the examinee was advised to undergo a full spine X-ray examination and Cobb angle measurement.The diagnostic criteria of AIS was Cobb angle≥10°measured on the standing anteroposterior full spine X-ray film.The age,gender,body mass index(BMI),waist-to-hip ratio and other basic conditions of the surveyed subjects were counted and analyzed.Additionally,the bending type and position distribution of AIS patients were summarized,as well as the distribution of AIS patients in different Cobb angle ranges.Results A total of 14,005 adolescents completed the survey in this study,and 354 cases of AIS were screened,with a prevalence rate of 2.5%(354/14,005),including 108 males and 246 females,with a prevalence rates of 0.8%and 1.8%,respectively.There was no significant difference in Cobb angles between males and females(P>0.05).There was a significant difference in waist-to-hip ratio between males and females(P<0.05).Among the 354 AIS patients,265(74.9%)cases had one-way bending,83(23.4%)cases had two-way bending,and 6(1.7%)cases had three-way bending.The most common location of scoliosis in adolescents with one-way bending was the lumbar spine.The Cobb angle of 90.5%of AIS patients was 10°-19°,and large angle bending was more common in girls.Conclusion The prevalence rate of AIS in adolescents in Guiyang is 2.5%.This prevalence is between 2%-3%of the overall incidence reported in previous literature studies in China,which is also similar to the prevalence reported in other countries.It is suggested that a wider range of AIS screening should be carried out in the future,and standardized training for school doctors should be carried out to better perform the screening work.