男性大角度青少年特发性脊柱侧凸影像学特征研究  

Radiographic characteristics of male adolescents with severe idiopathic scoliosis

作　　者：王渭君[1] 王智伟[1] 杨宗[1] 孙旭[1] 朱泽章[1] 朱锋[1] 邱勇[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华小儿外科杂志》2013年第5期361-365,共5页Chinese Journal of Pediatric Surgery

基　　金：基金项目：国家自然科学基金项目青年基金（编号：81101335）

摘　　要：目的研究Cobb角≥40°的男性青少年特发性脊柱侧凸（Adolescent idiopathic scolio—sis，AIS）弯型和影像学特征及其临床意义。方法回顾性分析2008至2009年问在我院初诊并行手术治疗的AIS患儿影像学资料。根据术前站立位及Bending位X线片分析侧凸的弯型及范围，测量计算侧凸Cobb角、柔韧性、胸椎后凸等。将AIs患儿根据弯型的典型／不典型以及特征进一步分组，比较男女患儿弯型分布、各亚组问男女患儿的影像学特征的差异。结果本研究共纳入91例男性和260例女性AIS患儿，两者骨龄一致。男性不典型侧凸的比例明显高于女性患JL（20．9％比10．0％，P〈0．01）。在具有典型侧凸的患儿中，不典型特征的分布无明显的性别差异；但与女性AIS相比，男性AIS具有较高比例的单胸弯（46．2％比33．8％，P〈O．01）及胸椎过度后凸（11．1％比2．O％，P〈0．01）。在具有结构性胸弯的典型侧凸中，男性患儿的胸弯Cobb角及胸椎后凸均较女性患儿大，胸弯柔韧性较女性小。结论Cobb角≥40。的AIS患儿的弯型、侧凸Cobb角及柔韧性、胸椎后凸均存在性别差异。男性AIS患儿中不典型侧凸的发病率明显高于女性患儿。典型侧凸患儿中，男性AIS单胸弯进展的概率可能较女性患儿高。男性AIS结构性侧凸较女性患儿僵硬可能与其支具治疗和手术矫形的效果较差有关；在具有结构性胸弯的男性AIS患儿中，胸椎过度后凸并不表明神经系统一定存在异常。Objective To investigate the curve patterns and radiographic characteristics in male adolescents with idiopathic scoliosis （AIS） with Cobb angle more than 40°. Methods The medical records and preoperative radiographs of patients who had surgery for treatment of AIS between 2008 and 2009, without any previous treatment for scoliosis, were retrospectively analyzed. The curve severity, flexibility, and thoracic kyphosis were analyzed on standing posteroanterior and lateral radiographs and side bending films. In addition, scoliosis curves were classified as typical or atypical in patterns and features for patient sub-group comparisons. Results 91 male and 260 female AIS patients were retrieved and both showed similar skeletal maturity. Atypical curves were more frequently observed in male patients （20. 9%） than in female （10. 0%） （P〈0. 01）. In patients with typical curve patterns, no gender difference was found in the distribution of atypical features. Males showed significantly higher incidence of major right thoracic curve, and greater frequency of hyperkyphosis than female patients. In patients who had typical curve patterns that included a major thoracic curve （single thoracic or double major curve patterns）, male patients had larger magnitude of thoracic curve, more severe thoracic kyphosis, and more rigid thoracic and lumbar curves compared to female patients. Conclusions There are radiographic differences in the curve patterns, severity of scoliosis and kyphosis,and spinal flexibility between female and male AIS patients with Cobb angle more than 40 . Atypical curve patterns were more predominant in male patients. In patients with typical curve patterns, the thoracic curve in male AIS might have higher risk of progression than that in female. The higher rigidity of both thoracic and lumbar curves in male AIS might contribute to the lower curvecorrection rate. In addition,male AIS patients with increased thoracic kyphosis may not have increased incidence of abnormal neural axis than in fe

关 键 词：脊柱侧凸 青少年 性别 胸椎 神经系统 

分 类 号：R687.3[医药卫生—骨科学]