Cobb angle progression in adolescent scoliosis begins at the intervertebral disc.
Cobb angle progression in adolescent scoliosis begins at the intervertebral disc.
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DOI：
10.1097/brs.0b013e3181c11853
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发表时间：
2009-12-01
期刊：
影响因子：
3
通讯作者：
Sanders JO
中科院分区：
文献类型：
--
作者：
Will RE;Stokes IA;Qiu X;Walker MR;Sanders JO
进行性特发性脊柱侧凸患者的纵向影像学研究。确定青少年骨骼生长和成熟的3个阶段中椎体和椎间盘楔入对Cobb角增加的相对贡献。在进行性脊柱侧凸中发现了椎间盘楔入和椎体楔入，但其对随时间推移的弯曲进展的相对贡献尚不清楚。哪一个先发生对于理解脊柱侧凸的进展和发展阻止进展的方法很重要。以前的研究没有正确识别成熟度，并提供相互矛盾的结果。18名女孩通过连续的脊柱和手骨龄X光片随访了青春期的生长突增。每个Cobb角又分为椎间盘楔角和椎体楔角。相应的手部X光片提供了一个成熟水平的衡量标准，即数字化骨骼年龄（DSA）。然后在3个生长阶段比较椎间盘与骨对Cobb角的贡献：生长突增之前、生长突增期间和生长突增之后。采用Wilcoxon双侧平均秩检验评估相对变化的显著性。在生长突增之前，椎间盘和骨（3° vs 0°，p=0.38）对弯曲进展的相对贡献没有差异。在生长突增期，平均椎间盘组件的进展明显大于椎骨（15° vs 0°，p=0.0002）。这在生长突增后发生逆转，椎体组件的进展大于椎间盘（10° vs 0°，p=0.01）。青少年特发性脊柱侧凸最初在快速生长期通过椎间盘楔入增加，随后发生进行性椎体楔入。
Longitudinal radiographic study of patients with progressive idiopathic scoliosis. To determine the relative contributions of vertebral and disc wedging to the increase in Cobb angle during 3 phases of adolescent skeletal growth and maturation. Both disc wedging and vertebral body wedging are found in progressive scoliosis, but their relative contribution to curve progression over time is unknown. Which occurs first is important for understanding how scoliosis progresses and for developing methods to halt progression. Previous studies have not properly identified maturity and provide conflicting results. Eighteen girls were followed through their adolescent growth spurt with serial spine and hand skeletal age radiographs. Each Cobb angle was divided into disc wedge angles and vertebral wedge angles. The corresponding hand radiographs provided a measure of maturity level, the Digital Skeletal Age (DSA). The disc versus bone contributions to the Cobb angle were then compared during 3 growth phases: prior to the growth spurt, during the growth spurt and after the growth spurt. Significance of relative changes was assessed with the Wilcoxon two-sided mean rank test. Prior to the growth spurt, there was no difference in relative contributions of the disc and the bone (3° vs 0°, p=0.38) to curve progression. During the growth spurt, the mean disc component progressed significantly more than that of the vertebrae (15° vs 0°, p=0.0002). This reversed following the growth spurt with the vertebral component progressing more than the disc (10° vs 0°, p=0.01). Adolescent idiopathic scoliosis initially increases through disc wedging during the rapid growth spurt with progressive vertebral wedging occurring later.