Geometric and electromyographic assessments in the evaluation of curve progression in idiopathic scoliosis
Geometric and electromyographic assessments in the evaluation of curve progression in idiopathic scoliosis
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DOI：
10.1097/01.brs.0000197155.68983.d8
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发表时间：
2006-02-01
期刊：
影响因子：
3
通讯作者：
Van Horn, JR
中科院分区：
文献类型：
--
作者：
Cheung, J;Veldhuizen, AG;Van Horn, JR
研究设计.在一项前瞻性纵向研究中，对特发性脊柱侧凸患者的自然病史进行了放射学和肌电图分析。确定特发性脊柱侧凸患者自然史中曲线进展过程中几何变量的变化以及这些变化发生的顺序。此外，研究几个几何变量和肌电图（EMG）测量之间的关系，以确定其作为脊柱侧凸畸形曲线进展风险因素的预测价值。背景资料概要。治疗青少年特发性脊柱侧凸的主要关注领域是在畸形早期发展过程中弯曲进展的不可预测性。分析了105例特发性脊柱侧凸患者在首次就诊和连续4-6个月随访期间影像学几何学和肌电图变量的变化。进行统计学分析以更详细地阐明脊柱几何形状在曲线进展过程中如何演变。弯曲的严重程度与剩余的生长潜力相关，表示为增加的脊柱生长速度（SGV）。随着SGV的增加，曲线凸侧下部的EMG活动增强，表示为EMG比值，在Cobb角快速增加之前，高EMG比值与轴向旋转增加和脊柱后凸减少有关。侧偏、楔角和轴向旋转均在进展期间增加。倾斜角和脊柱前凸的变化与弯曲进展无关。在特发性脊柱侧凸的自然病程中，椎体下端SGV和EMG比值是脊柱侧弯进展的重要危险因素。不对称的肌肉活动与轴向旋转增加相关，轴向旋转增加又与Cobb角增加和脊柱后凸减少相关。这些变量的组合提供了对特发性脊柱侧凸弯曲进展自然史的生理和三维生物力学演变的深入了解。
Study Design. The natural history of patients with idiopathic scoliosis was analyzed radiographically and electromyographically in a prospective longitudinal study.Objectives. To identify changes in geometric variables and the sequence in which these changes occur during curve progression in the natural history of patients with idiopathic scoliosis. In addition, to study the relationship between several geometric variables and electromyographic (EMG) measurements to determine their predictive value as risk factors to curve progression of the scoliotic deformity.Summary of Background Data. The main area of concern in treating children with adolescent idiopathic scoliosis is the unpredictability of curve progression during the early development of the deformity.Methods. The changes in radiographic geometric and EMG variables between the first presentation and consecutive 4-6-month follow-up periods were analyzed in 105 patients with idiopathic scoliosis. Statistical analyses were performed to elucidate in more detail how spinal geometry evolves during curve progression.Results. Curve severity was associated with remaining growth potential expressed as an increasing spinal growth velocity (SGV). With increasing SGV, an enhanced EMG activity at the lower part on the convex side of the curve expressed as EMG ratio was found. High EMG ratio was associated with increased axial rotation and diminished kyphosis before the rapid increase in Cobb angle. Lateral deviation, wedge angle, and axial rotation all increased during periods of progression. Changes in tilt angle and lordosis were not associated with curve progression.Conclusions. In the natural history of idiopathic scoliosis, SGV and EMG ratio at the lower end vertebra are prominent risk factors of curve progression. The asymmetric muscle activity is associated with increased axial rotation, which in its turn is associated with increasing Cobb angle and diminishing kyphosis. The combination of these variables provides insight in the physiologic and 3-dimensional biomechanical evolution of the natural history of curve progression in idiopathic scoliosis.