重度胸段青少年特发性脊柱侧凸患者的矢状位平衡参数评估

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论证。近年来，矢状位平衡的概念在不同病因所致脊柱畸形患者的治疗中愈发重要。关于特发性脊柱侧凸患者矢状位平衡参数的研究多为零散个例，且很少纳入重度患者。

目的：评估重度胸段特发性脊柱侧凸青少年患者的整体及区域性矢状位平衡参数。

材料与方法。纳入45例12–17岁的青少年胸段特发性脊柱侧凸患者（Lenke分型为第1、2、3型），主弯 Cobb角范围为80°至150°。所有患者均接受X线检查，评估其区域性和整体矢状位平衡参数及冠状面脊柱畸形特征。根据整体矢状位平衡参数的数值将患者分为两组。所得数据接受了描述性、 相关性、回归和比较性统计分析。

结果。冠状面脊柱畸形程度与胸椎后凸角之间存在正相关。回归分析显示，当主弯角度超过约100°时， 胸椎后凸角往往超过60°。胸椎后凸角（thoracic kyphosis）的增大是该类患者矢状面畸形的主要表现，但无论是胸椎后凸角还是冠状面主弯角度，与任何整体矢状位平衡指标均无统计学显著相关。 矢状位平衡参数更多地与脊柱-骨盆参数（PI、PT、SS、LL、PI–LL）相关。

结论。在手术治疗重度特发性脊柱侧凸时，必须考虑采用对后凸成分具有矫正效果的矫形方法。 即便在主弯角度极大的情况下，胸段特发性脊柱侧凸患者也不典型地表现出明显的前方矢状位失衡。其主要风险因素包括较低的PI和LL值。该类患者所呈现出的相关性机制目前尚未被完全阐明。

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作者简介

Sergei V. Vissarionov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN 代码: 7125-4930

MD, PhD, Dr. Sci. (Medicine), Professor, Corresponding Member of RAS

俄罗斯联邦, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

Timofey S. Rybinskikh

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: timofey1999r@gmail.com
ORCID iD: 0000-0002-4180-5353
SPIN 代码: 7739-4321

MD

俄罗斯联邦, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

Marat S. Asadulaev

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: marat.asadulaev@yandex.ru
ORCID iD: 0000-0002-1768-2402
SPIN 代码: 3336-8996

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

Dmitriy N. Kokushin

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: partgerm@yandex.ru
ORCID iD: 0000-0002-2510-7213
SPIN 代码: 9071-4853

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

Sergei M. Belyanchikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: beljanchikov@list.ru
ORCID iD: 0000-0002-7464-1244
SPIN 代码: 9953-5500

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

Vakhtang G. Toria

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: vakdiss@yandex.ru
ORCID iD: 0000-0002-2056-9726
SPIN 代码: 1797-5031

MD

俄罗斯联邦, 64–68 Parkovaya st., Pushkin, Saint Petersburg, 196603

参考

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2. Fig. 1. Distribution of patients by types of deformation, according to the Lenke classification: A, B, C — lumbar modifiers according to the Lenke classification.

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3. Fig. 2. Results of regression analysis reflecting the relationship between the measured radiographic parameters: a — between the magnitude of the primary curvature arc and thoracic kyphosis (TK) (R=0.72; R2=0.51); b — between TK and lumbar lordosis (LL) (R=0.41; R2=0.17); c — between LL and the spinal sacral angle (SSA) (R=0.69; R2=0.48); d — between SSA and the pelvic angle (PI) (R=0.66; R2=0.44).

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4. Fig. 3. Patient, 17 years old. Diagnosis: Idiopathic S-shaped scoliosis of the IV degree (Lenke 3B). The magnitude of the primary curve is 135°, secondary curve of the lumbar spine is 70°, rotation of the apical vertebra is 87°, thoracic kyphosis is 116°, lumbar lordosis (LL) is 102°, pelvic angle (PI) is 43°, pelvic deviation (PT) is 0°, sacral tilt (SS) is 43°, the difference between the values ​​of the pelvic index and lumbar lordosis (PI–LL) is –58°, spinal sacral angle (SSA) is 140°, T1/pelvic angle is –6°, sagittal vertical axis (SVA) is –21 mm.

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