综合征(22q11.2DS)人群的脊柱早期矢状面形状可预测脊柱侧弯的发展:一项前瞻性纵向研究

Steven de Reuver,Jelle F Homans,Michiel L Houben,Tom P C Schlösser,Keita Ito,Moyo C Kruyt,René M Castelein
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引用次数: 0

摘要

背景脊柱侧弯症是脊柱和躯干的一种畸形,严重时会造成终生的疾病负担,需要强化治疗。青少年特发性脊柱侧弯症是最常见的一种脊柱侧弯症,目前尚无明确的潜在病症,其病理机制似乎是多因素的;不过,有观点认为脊柱的生物力学在其中发挥了作用。对于非特发性脊柱侧凸,虽然可以确认潜在的疾病,但畸形的驱动因素仍不清楚。在本研究中,我们研究了22q11.2缺失综合征(22q11.2DS)患儿脊柱侧弯发病前的早期脊柱矢状面形态。这项前瞻性队列研究纳入了22q11.2DS患者,他们在青春期成长过程中均接受了脊柱X光片随访。所有患儿最初在骨骼尚未发育成熟时(里瑟0期和1期)都没有脊柱侧凸,我们每隔两年对他们进行一次随访,直到他们骨骼发育成熟(里瑟3期至5期)。我们评估了之前被证明旋转不稳定的脊柱后倾段,以确定它是否能预测日后脊柱侧凸的发展。为了进行量化,测量了 "后倾三角形"(PIT)的面积,这是以前描述过的一个参数,综合了危险节段的倾斜度和长度。结果 在最初没有脊柱侧凸的50名儿童中(纳入时平均年龄为10.7 ± 1.7岁;平均随访时间为4.8 ± 1.6年),有24名(48%)患上了脊柱侧凸。纳入时PIT面积高于平均水平(>60平方厘米)的患者发生脊柱侧凸的相对风险为2.55(95%置信区间[CI]:1.22至5.34)。PIT倾斜度与脊柱侧弯类型相关:较高且较陡的下斜面预示日后会出现胸椎侧弯,而较短且较不陡的倾斜度预示会出现(胸)腰椎侧弯。结论这项前瞻性研究发现,脊柱侧弯前的矢状面形状是22q11.2DS患儿日后发生脊柱侧弯的风险因素。有关证据等级的完整描述,请参阅 "作者须知"。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early Sagittal Shape of the Spine Predicts Scoliosis Development in a Syndromic (22q11.2DS) Population: A Prospective Longitudinal Study.
BACKGROUND Scoliosis is a deformation of the spine and trunk that, in its more severe forms, creates a life-long burden of disease and requires intensive treatment. For its most prevalent form, adolescent idiopathic scoliosis, no underlying condition can be defined, and the pathomechanism appears to be multifactorial; however, it has been suggested that the biomechanics of the spine play a role. For nonidiopathic scoliosis, underlying conditions can be recognized, but what drives the deformity remains unclear. In this study, we examined the early sagittal shape of the spine before the onset of scoliosis in a population with 22q11.2 deletion syndrome (22q11.2DS). This cohort was chosen since children with this syndrome have an approximately 50% chance of developing scoliosis that shares certain characteristics with idiopathic scoliosis, namely, age of onset, curve morphology, and rate of progression. METHODS This prospective cohort study included patients with 22q11.2DS who were followed with the use of spinal radiographs during adolescent growth. All of the children, who initially had no scoliosis while still skeletally immature (Risser stages 0 and 1), were followed at 2-year intervals until they reached skeletal maturity (Risser stages 3 to 5). We assessed the segment of the spine that has previously been shown to be rotationally unstable, the posteriorly inclined segment, to determine if it was predictive of later scoliosis development. For quantification, the area of the "posteriorly inclined triangle" (PIT), a previously described parameter that integrates both the inclination and length of the at-risk segment, was measured. RESULTS Of the 50 children who initially had no scoliosis (mean age at inclusion, 10.7 ± 1.7 years; mean follow-up, 4.8 ± 1.6 years), 24 (48%) developed scoliosis. Patients with an above-average PIT area (>60 cm2) at inclusion showed a relative risk of 2.55 for scoliosis development (95% confidence interval [CI]:1.22 to 5.34). PIT inclination was correlated with curve type: a taller and steeper hypotenuse predicted later thoracic scoliosis, while a shorter and less steep inclination predicted the development of (thoraco)lumbar scoliosis. CONCLUSIONS This prospective study identified the pre-scoliotic sagittal shape of the spine as a risk factor for the later development of scoliosis in the population of children with 22q11.2DS. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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