不同观测视角对胸弯型青少年特发性脊柱侧凸患儿双肩美学评估的影响  

Effect of different observations on evaluation of cosmetic shoulder balance in adolescent idiopathic scoliosis patients with thoracic curve

作　　者：李东岳 刘臻[1,2] 胡宗杉 李劼 刘昌伟 许彦劼 邱勇[1,2] 朱泽章[1,2] Li Dongyue;Liu Zhen;Hu Zongshan;Li Jie;Liu Changwei;Xu Yanjie;Qiu Yong;Zhu Zezhang(Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China;Divisionof Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院骨科脊柱外科,南京210008 [2]南京大学医学院附属鼓楼医院骨科脊柱外科,南京210008

出　　处：《中华医学杂志》2024年第1期22-30,共9页National Medical Journal of China

基　　金：十三五南京市卫生人才培养计划(QRX17126);江苏省333高层次人才培养工程[(2022)3-1-238];南京市重点科技发展项目(SB9320202202)

摘　　要：目的探讨不同观测视角下胸弯型青少年特发性脊柱侧凸(AIS)患儿双肩美学指标的差异及各视角下AIS患儿双肩美学指标与影像学指标的相关性和临床意义,为临床治疗评估提供参考。方法回顾性纳入分析2022年7至10月连续于南京鼓楼医院接受治疗的43例胸弯型AIS患儿的临床及影像学资料。其中男9例,女34例;年龄(14.3±1.5)岁。所有患儿均在术前摄立位全脊柱正侧位片与前方、后方的肩部水平及较高水平(与地面垂直距离固定为180 cm)外观照。于外观照测量以下6个美学指标:肩角(α_(1))、腋窝角(α_(2))、肩部面积指数1(SAI_(1))、肩部面积指数2(SAI_(2))、内肩高度差(SHi)、外肩高度差(SHo);于X线片测量以下8个影像学指标:影像肩高差(RSHD)、第一肋角(FRA)、锁骨肋骨交点高度差(CRCI)、喙突高度差(CPH)、T_(1)倾斜(T_(1)tilt)、锁骨角(CA)、锁骨胸廓角度差(CCAD)、Cobb角。分析比较不同视角下各双肩美学指标间是否存在差异及其与双肩影像学指标间的相关性。结果在同一水平面上,所研究美学指标在患儿前方及后方的差异均无统计学意义(均P>0.05)。但同在患儿后方观测时,可观察到SHo、SHi、α_(1)及α_(2)在肩部水平所测结果均高于较高观测点所测结果[SHo:(0.11±1.20)cm比(-0.44±1.39)cm,P=0.005;SHi:(0.64±0.86)cm比(0.32±0.56)cm,P=0.003;α_(1):-0.47°±2.27°比-0.77°±2.49°,P=0.014;α_(2):-3.06°±3.23°比-2.21°±3.03°,P=0.034],且SHi及SHo对此高度差异更为敏感,于前方视角观测时所得结论相同[SHo:(0.12±1.29)cm比(-0.48±1.35)cm,P=0.007;SHi:(0.61±0.88)cm比(0.30±0.59)cm,P=0.006;α_(1):-0.46°±2.18°比-0.69°±2.35°,P=0.018;α_(2):-3.26°±3.12°比-2.05°±2.97°,P=0.029]。于肩部水平所测美学指标与影像学指标间相关系数范围为0.374~0.767,较高观测点所测美学指标与影像学指标间的相关系数范围为0.273~0.579(均P<0.05)。结论不同观测系间所得胸弯型AIS患�Objective To investigate the correlations between cosmetic and radiographic parameters of shoulder balance,as well as the variations in cosmetic shoulder balance observed from different perspectives,among patients with adolescent idiopathic scoliosis(AIS)characterized by thoracic curves.Methods A total of 43 patients with thoracic curves treated from July to October in 2022 in Nanjing Drum Tower Hospital were recruited in this study.There were 9 males and 34 females with a mean age of(14.3±1.5)years.All participants underwent comprehensive radiographic assessments and were photographed both from posterior and anterior views,focusing on the shoulder region as well as a higher level(maintaining a consistent vertical distance of 180 cm from the ground).Six cosmetic parameters were measured on the photographs:shoulder angle(α_(1)),axilla angle(α_(2)),shoulder area index 1(SAI_(1)),shoulder area index 2(SAI_(2)),inner shoulder height(SHi)and outer shoulder height(SHo).Eight radiographic parameters were measured on the radiographs:radiographic shoulder height difference(RSHD),first rib angle(FRA),clavicle-rib cage intersection(CRCI),coracoid process height(CPH),T_(1)tilt,clavicle angle(CA),clavicle chest cage angle difference(CCAD)and Cobb angle.Differences among bilateral cosmetic indicators from different perspectives were analyzed and compared,and their correlation with bilateral radiographic indicators was studied.Results There was no significant differences between anterior cosmetic parameters and posterior cosmetic parameters at the same level of observation(all P>0.05).However,when observing SHi,SHo,α_(1),andα_(2)at the shoulder level,it became evident that they exhibited significantly higher values compared to the corresponding higher level on the same side of the patients′bodies.This contrast was observed in both the dorsal[SHo:(0.11±1.20)cm vs(-0.44±1.39)cm,P=0.005;SHi:(0.64±0.86)cm vs(0.32±0.56)cm,P=0.003;α_(1):-0.47°±2.27°vs-0.77°±2.49°,P=0.014;α_(2):-3.06°±3.23°vs-2.21°±3.03°,P=0.0

关 键 词：脊柱侧凸 青少年特发性脊柱侧凸 人体测量术 肩 美学 多视角观测 

分 类 号：R726.8[医药卫生—儿科]