支点弯曲位X线片在辅助青少年脊柱侧凸柔韧性评估中的作用  

Role of fulcrum bending roentgenograph in evaluation of flexibility in adolescent idiopathic scoliosis patients

作　　者：栗景峰[1] 杨宗德[1] 张国友[1] 陈自强[1] 杨长伟[1] 白玉树[1] 李明[1] 

机构地区：[1]第二军医大学附属长海医院骨科,上海200433

出　　处：《脊柱外科杂志》2011年第6期327-332,共6页Journal of Spinal Surgery

摘　　要：目的评估支点弯曲位X线片在特发性脊柱侧凸近端胸弯(proximal thoracic,PT),主胸弯(main thoracic,MT)和胸腰弯/腰弯(thoracolumbar/lumbar,TL/L)冠状位矫形中的作用。方法本研究包括38例连续的行单纯后路椎弓根螺钉矫形固定融合术的青少年脊柱侧凸患者。影像学评估包括术前站立前后位X线片、支点弯曲位X线片,仰卧侧曲位X线片以及术后站立前后位及侧位X线片。测量患者的Cobb角并计算支点弯曲影像(fulcrum bendingradiograph,FBR)柔韧性及支点弯曲矫正指数(fulcrum bending correction index,FBCI)。术后影像学资料包括术后即刻(1周)、3个月、6个月、12个月以及2年随访时的X线片。结果本研究手术节段包括9例PT,37例MT,9例TL/L。平均手术年龄为15.1岁。术前PT组、MT组和TL/L组的FBR柔韧性分别为42.6%、61.1%和66.2%;而平均手术矫正率分别为43.4%、69.3%和73.9%;平均FBCI分别为103.8%、117.0%和114.8%。FBR柔韧性正相关于手术矫正率。尽管MT组和TL/L组的手术矫正率高于PT组,3组的FBCI差异无统计学意义(P<0.05)。结论支点弯曲位X线片可以用来辅助青少年脊柱侧凸患者的柔韧性评估。采用支点弯曲位X线片对侧凸的柔韧性加以评估后发现,椎弓根螺钉对PT、MT和TL/L的矫形能力是相同的。Objective To determine the role of fulcrum bending reontgenograph in assessing the proximal thoracic（PT）,main thoracic（MT）,and the thoracolumbar/lumbar（TL/L） curves in patients undergoing coronal plane correction for adolescent idiopathic scoliosis（AIS）.Methods Thirty-eight consecutive AIS patients who underwent pedicle screw fixation and posterior fusion were recruited in this study.The assessment of preoperative radiographs included standing posterior-anterior（PA）,fulcurm bending,supine side-bending,and postoperative standing PA and lateral reontgenographs.Cobb＇s angles were obtained for the PT,MT,and TL/L curves,and the curve flexibility as well as fulcrum bending correction index（FBCI） were calculated for all patients.Postoperatively,radiographs were assessed at immediate（i.e.1 week）,3 months,6 months,12 months and 2 years follow-up.Results The patients consisted of PT curve in 9 cases,MT curve in 37 cases,and TL/L curve in 12 cases,with a mean age of 15.1 years.The mean fulcurm bending radiograph（FBR） flexibility of PT,MT,and TL/L curves was 42.6%,61.1%,and 66.2%,respectively,and the corresponding mean operative correction rates were 43.4%,69.3%,and 73.9%,with the mean FBCI being 103.8%,117.0%,and 114.8%,respectively.FBR flexibility was positively correlated with the operative correction rate in PT,MT,and TL/L curves.Although the correction rate in MT and TL/L curves was higher than that in PT curves,the FBCI in the 3 types of curves had no significant difference（P0.05）.Conclusion Fulcrum bending reontgenograph is helpful in flexibility assessment of PT,MT,and TL/L curves in AIS patients.With the aid of fulcrum bending reontgenograph for curve flexibility,pedicle screws exert same effect on the correction of PT,MT and TL/L curves.

关 键 词：青少年 脊柱侧凸 柔韧性 放射摄影术 

分 类 号：R682.3[医药卫生—骨科学]