青少年特发性双胸弯患者肩部影像学平衡与美学平衡的相关性研究

目的 探讨Lenke2型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis, AIS)患者肩部影像学指标与美学指标之间的相关性.方法 对34例Lenke2型的AIS患者进行研究,提出了评价AIS患者肩部美学平衡的6个指标:内侧双肩高度差(Shi)、外侧双肩高度差(Sho)、肩部面积指数1(SAI1)、肩部面积指数2(SAI2)、肩角(α1)、腋窝角(α2)并在照片上进行测量;同时在X线片上测量7个评价AIS患者肩部影像学平衡的指标:T1倾斜(T1)、第一肋角(FRA)、锁骨角(CA)、喙突高度差(CPH)、锁骨助骨交点高度差(CRCI)、第一肋锁骨距离差(FRCH)、斜方肌不对称性(TL).美学指标与影像学指标之间进行相关分析.结果 Shi与各影像学指标之间的相关系数范围为-0.12～0.61,其中与T1、FRA、CA、CPH、CRCI呈显著相关.Sho与各影像学指标之间的相关系数范围为-0.22～0.74,其中与T1、FRA、CA、 CPH、CRCI. FRCH呈显著相关.但是,所有的相关系数都小于0.8.SAI1、SAI2、α1、α2与影像学指标之间的相关系数同样也都小于0.8.结论 影像学指标可以部分反映肩部的美学外观,但是没有一个影像学指标可以精确地反映肩部的美学外观.因此,建议在评价Lenke2型AIS患者肩部平衡时,在采用影像学指标的同时,美学指标应作为一种补充.

Double thoracic adolescent idiopathic scoliosis: clinical evaluation of shoulder balance

Objective To develop several cosmetic parameters for the evaluation of cosmetic shoul-der balance and to investigate the correlation between radiographic and cosmetic shoulder balance in adoles-cent idiopathic scoliosis (AIS) patients with Lenke 2 curve. Methods Thirty-four AIS patients with Lenke 2 curve were recruited for this study. Six cosmetic parameters-inner shoulder height (SHi), outer shoulder height (SHo), shoulder area index 1 (SAI1), shoulder area index 2 (SAI2), shoulder angle (α1) and axilla an-gle (α2) were developed and measured on the standing photographs. Also, seven radiographic parameters-T1 tilting (T1), first rib angle (FRA), clavicle angle (CA), coracoid process height (CPH), clavicle-rib cage inter-section (CRCI), first rib-clavicle height (FRCH), trapezius length (TL) were measured on the standing posteri-or-anterior radiographs. Correlation analysis was made between cosmetic parameters and radiographic pa-rameters. Results The correlation coefficients between SHi and radiographic parameters ranged from -0.12 to 0.61, and SHi was found to be significantly correlated with T1, FRA, CA, CPH and CRCI, among which FRA had the highest correlation coefficient. The correlation coefficients between SHo and radiographic pa-rameters ranged from -0.22 to 0.74, and Silo was significantly correlated with T1, FRA, CA, CPH, CRCI and FRCH, among which CRCI had the highest correlation coefficient. There were also several radiographic parameters correlated significantly with SAI1, SAI2, α1 and α2. Although significant correlation were found between radiographic parameters and cosmetic measurements, none of the correlation coefficient was greater than 0.8. Conclusion Radiographic parameters could partially reflect the shoulder cosmetic appearances. However, none of the existing parameters can accurately reflect the shoulder cosmetic appearance. Hence, we suggest that some of the cosmetic parameters should serve as a supplement to the radiographic parame-ters in the evaluation of shoulder balance clinically.