NF-1伴非萎缩型胸椎侧凸与胸弯型AIS及正常青少年矢状面形态的比较研究  

Sagittal spino-pelvic alignment in non-dystrophic thoracic scoliosis secondary to NF-1:a comparison with AIS and normal control

作　　者：杨宗[1] 朱泽章[1] 邱勇[1] 王渭君[1] 周松[1] 沙士甫[1] 伍伟飞[1] 王守丰[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,南京210008

出　　处：《中国矫形外科杂志》2013年第15期1533-1537,共5页Orthopedic Journal of China

基　　金：江苏省自然科学基金(项目编号:BK2010109);六大人才高峰(项目编号:07-B-027)

摘　　要：[目的]探讨青少年I型神经纤维瘤病(neurofibromatosis type 1,NF-1)伴非萎缩型胸椎侧凸与青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者及正常青少年矢状面脊柱、骨盆形态的差异。[方法]回顾分析2001年1月～2012年12月期间在本院手术治疗且侧凸Cobb角<70°的15例NF-1伴非萎缩型胸椎侧凸青少年患者(NF-1组)。选择与NF-1患者年龄、性别、弯型以及侧凸Cobb角匹配的15例AIS患者(AIS组)进行比较,并以年龄、性别匹配的30名正常青少年作对照(control group,CTL组)。全部研究对象均拍摄站立位全脊柱正侧位X线片并测量以下参数评估矢状面的形态:胸椎后凸角、胸腰段交界角、腰椎前凸角、骨盆入射角、骨盆倾斜角、骶骨倾斜角、脊柱倾斜度和脊柱骶骨角。采用单因素方差分析三组矢状面各参数的异同。[结果]15例NF-1患者中TK不足者及后凸畸形各1例,其余13例均为正常范围(10°～40°),NF-1组平均TK为(25.6±7.6)°,明显大于AIS组的(16.5±5.4)°(P<0.05);NF-1组LL为(-53.8±6.4)°,AIS为(-47.8±4.2)°,两者有显著性差异(P<0.05)。NF-1组与CTL组比较显示各参数均无统计学差异(P>0.05)。[结论]NF-1伴非萎缩型胸椎侧凸患者矢状面形态与正常青少年无明显差异:没有明显的胸椎后凸畸形,也无AIS患者明显胸椎后凸不足表现,提示此类患者术后远期矢状面上的并发症可能与术前的矢状面形态无明显相关性。[ Objective] To compare sagittal spino - pelvic alignment in neurofibromatosis type - 1 （ NF - 1 ） associated with nondystrophic thoracic scoliosis, adolescent idiopathic scoliosis （AIS）, and normal control. [ Methods] Fifteen NF- 1 patients with non - dystrophic thoracic scoliosis （ group NF - 1 ） less than 70 degrees were reviewed. Fifteen AIS patients （ group AIS） matched for age, gender, curve pattern and Cobb angle were selected for comparison. In addition, age - and gender - matched healthy adolescents were recruited as control （ group CTL, n = 30） . On standing full - spine lateral X - rays, the fol- lowing parameters were measured： thoracic kyphosis （TK） , thoracolumbar junctional angle （TLJ） , lumbar lordosis （LL） , pel- vic incidence （PI）, pelvic tilt （PT）, sacral slope （SS）, spinal tilt （ST） and spinal- sacral angle （SSA） . [ Results] For the NF - 1 group, the TK of 13 patients was within the normal range （ 10° - 40°） with hyperhyphosis and hypohyphosis presen- ting in 1 each. The average TK of the NF - 1 group was significant larger than that in the AIS group （5.6° - 7. 6°versus 16. 5° - 5.4°, P 〈0. 05） , and significant difference was found between the two groups in LL （ -53.8°versus -47. 8°, P 〈0.05）. However, no significant differences were noted between the NF - 1 and the CTL group in all eight sagittal parameters. [ Conclusion] The sagittal profile in non - dystrophic thoracic scoliosis secondary to NF - 1 is similar to that in age - and gender - matched healthy adolescents, that is, either significant hypohyphosis, an obvious characteristic in AIS patients, or obvious hype- rhyphosis occurs in NF - 1 group. The postoperative sagittal decompensation might not be related to the preoperative sagittal alignment in NF - 1 patients with non - dystrophic thoracic scoliosis.

关 键 词：I型神经纤维瘤病 非萎缩型脊柱侧凸 特发性脊柱侧凸 矢状面形态 

分 类 号：R682[医药卫生—骨科学]