目的 探讨青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）支具治疗后肩平衡相关参数变化及影响因素。 方法 选择2012年6月至2021年12月我院支具治疗的82例AIS患者，分别于治疗前及治疗后末次随访时拍摄自然站立位全脊柱正侧位X线片，根据治疗后影像学肩关节高度差（radiographic shoulder height，RSH）分级绝对值是否大于治疗前将患者分为双肩平衡组和双肩失衡组。对比两组患者肩平衡参数，分析RSH与其他影像学参数的相关关系，多因素分析探讨AIS患者支具治疗后双肩失衡的影响因素。 结果 治疗后肩失衡发生率为23.17%，支具治疗前，双肩失衡组锁骨角（clavicular angle，CA）、锁骨轮廓角度差（clavicular contour angle difference，CCAD）均高于双肩平衡组（P<0.05）。与治疗前比较，两组患者治疗6个月及2年后RSH、上胸弯Cobb角、主胸弯Cobb角、CA及T1倾斜角均显著改善，双肩平衡组改善效果更佳（P<0.05）。双肩失衡患者治疗后RSH与治疗前CA及CCAD呈显著正相关（r=0.896、0.882，P<0.05），与上胸弯柔韧度呈显著负相关（r=-702，P<0.05）；治疗后RSH变化与CA变化、上胸弯角度变化、上胸弯矫正率、主胸弯角度变化、主胸弯矫正率呈显著正相关（r=0.906、0.644、0.708、0.815、0.878，P<0.05）。Risser征>3、初发Cobb角≥35°及椎体旋转度≥Ⅲ度是患者支具治疗后双肩失衡的独立危险因素（P<0.05）。 结论 AIS患者经支具治疗后RSH、上胸弯Cobb角、主胸弯Cobb角、CA及T1倾斜角均显著改善，Risser征、初发Cobb角及椎体旋转度是AIS患者支具治疗后双肩失衡的独立危险因素。
Abstract
Objective To explore the changes of balance related parameters and influencing factors in adolescent idiopathic scoliosis (AIS) after brace treatment. Methods A total of 82 patients with AIS who received brace treatment in our hospital from June 2012 to December 2021 were selected as the research objects. Before treatment and at the last follow-up after treatment, X-ray films of the whole spine in the natural standing position were taken. According to whether the absolute value of radiographic shoulder height (RSH) after treatment was greater than that before treatment, the patients were divided into the double shoulder balance group and the double shoulder imbalance group. The shoulder balance parameters of the two groups were compared, and the correlation between RSH and imaging indexes was analyzed. The influencing factors of shoulder imbalance in patients with AIS after brace treatment were discussed by multivariate Logistic regression analysis. Results After treatment, the incidence of shoulder imbalance was 23.17%. Before brace treatment, clavicular angle (CA) and clavicular contour angle difference (CCAD) in the double shoulder imbalance group were higher than those in the double shoulder balance group (P<0.05). Compared with before treatment, RSH, upper thoracic curve Cobb angle, main thoracic curve Cobb angle, CA and T1 inclination angle were significantly improved in the two groups after 6 months of treatment and 2 years of treatment, and the improvement effect was better in the double shoulder balance group (P<0.05). RSH after treatment was significantly positively correlated with CA and CCAD before treatment in the double shoulder imbalance group (r=0.896, 0.882, P<0.05), and negatively correlated with upper chest bending flexibility (r=-702, P<0.05). The change of RSH after treatment was significantly positively correlated with the change of CA, the change of upper thoracic curvature angle, the correction rate of upper thoracic curvature, the change of main thoracic curvature angle and the correction rate of main thoracic curvature (r=0.906, 0.644, 0.708, 0.815, 0.878, P<0.05). Risser's sign > 3, initial Cobb's angle ≥ 35° and vertebral rotation ≥ III degree were independent risk factors for shoulder imbalance after brace treatment (P<0.05). Conclusions RSH, upper thoracic curve Cobb angle, main thoracic curve Cobb angle, CA and T1 tilt angle were significantly improved in AIS patients after brace treatment. Risser’s sign, initial Cobb angle and vertebral rotation were independent risk factors for shoulder imbalance in AIS patients after brace treatment.
关键词
青少年特发性脊柱侧凸； /
支具治疗； /
肩平衡； /
/
影响因素
Key words
Adolescent idiopathic scoliosis; /
/
Brace treatment; /
/
Shoulder balance; /
/
Influence factor
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基金
贵州省科技计划项目（黔科合平台人才[2018]5614）
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