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Abstract：
OBJECTIVE: To investigate the effects of bracing on apical vertebral derotation and explore the factors that influence in-brace derotation effects in adolescent idiopathic scoliosis (AIS) patients. For patients with AIS, vertebral rotation causes cosmetic appearance abnormalities and acts as an indicator for curve progression. However, there have been few studies investigating the precise derotation effects of bracing for apical vertebra. The application of EOS imaging system enables quantitative evaluation of vertebral rotation in the axial plane in a standing position.
METHODS: There were 82 eligible patients enrolled in current study, who underwent EOS imaging evaluation before and immediately after bracing. The clinical demographic data (age, gender, Risser sign and menstrual status) were recorded. The correlation analyses between derotation effects and key parameters (age, pre-brace Cobb angle, thoracic kyphosis, lumbar lordosis, vertebral rotation, pelvis axial rotation and apical vertebral level) were performed. The in-brace derotation effects stratified by gender, Risser sign, apical vertebral level, menarche status, coronal balance and sagittal balance were also analyzed.
RESULTS: The rotation of apical vertebra was decreased from 8.8 ± 6.0 degrees before bracing to 3.8 ± 3.3 degrees immediately after bracing (p < 0.001), and the derotation rate was 49.2 ± 38.3%. The derotation degrees in brace was significantly correlated with major curve Cobb angle (r = 0.240, p = 0.030), minor curve Cobb angle (r = 0.256, p = 0.020) and total curve Cobb angle (r = 0.266, p = 0.016). Both the pre-brace apical vertebral rotation and apical vertebral level were significantly correlated with derotation effects in brace (p < 0.001). Patients with thoracic major curve showed worse derotation effects than those with lumbar major curve (p < 0.001). In addition, patients with coronal balance showed better in-brace derotation effects than those with coronal decompensation (p = 0.005).
CONCLUSIONS: A satisfactory apical vertebral derotation rate (approximately 50%) could be obtained immediately after bracing in AIS patients. Pre-brace Cobb angle of curve, pre-brace apical vertebral rotation, apical vertebral level and coronal balance exhibited close associations with in-brace derotation effects of apical vertebra.
METHODS: There were 82 eligible patients enrolled in current study, who underwent EOS imaging evaluation before and immediately after bracing. The clinical demographic data (age, gender, Risser sign and menstrual status) were recorded. The correlation analyses between derotation effects and key parameters (age, pre-brace Cobb angle, thoracic kyphosis, lumbar lordosis, vertebral rotation, pelvis axial rotation and apical vertebral level) were performed. The in-brace derotation effects stratified by gender, Risser sign, apical vertebral level, menarche status, coronal balance and sagittal balance were also analyzed.
RESULTS: The rotation of apical vertebra was decreased from 8.8 ± 6.0 degrees before bracing to 3.8 ± 3.3 degrees immediately after bracing (p < 0.001), and the derotation rate was 49.2 ± 38.3%. The derotation degrees in brace was significantly correlated with major curve Cobb angle (r = 0.240, p = 0.030), minor curve Cobb angle (r = 0.256, p = 0.020) and total curve Cobb angle (r = 0.266, p = 0.016). Both the pre-brace apical vertebral rotation and apical vertebral level were significantly correlated with derotation effects in brace (p < 0.001). Patients with thoracic major curve showed worse derotation effects than those with lumbar major curve (p < 0.001). In addition, patients with coronal balance showed better in-brace derotation effects than those with coronal decompensation (p = 0.005).
CONCLUSIONS: A satisfactory apical vertebral derotation rate (approximately 50%) could be obtained immediately after bracing in AIS patients. Pre-brace Cobb angle of curve, pre-brace apical vertebral rotation, apical vertebral level and coronal balance exhibited close associations with in-brace derotation effects of apical vertebra.
摘要：
目的：探讨青少年特发性脊柱侧凸(AIS)患者行支撑对根尖旋转的影响及影响因素。对于AIS患者，椎体旋转会导致外观异常，并作为曲线进展的指标。然而,很少有研究研究根尖椎骨支撑的精确旋转效果。EOS成像系统的应用能够定量评估站立姿势中轴向平面中的椎骨旋转。
方法：本研究纳入82名符合条件的患者，在支撑之前和之后立即接受了EOS成像评估。临床人口统计数据(年龄，性别,记录Riser体征和月经状态）。偏离效应与关键参数(年龄，前撑科布角,胸椎后凸,腰椎前凸,椎骨旋转,进行骨盆轴向旋转和根尖椎体水平）。按性别分层的内支撑偏差效应，Risser标志,顶椎水平，初潮状态，还分析了冠状平衡和矢状平衡。
结果：顶椎的旋转从支撑前的8.8±6.0度下降到支撑后立即的3.8±3.3度（p<0.001），降低率为49.2±38.3%。支具的旋转度与主要曲线Cobb角显着相关（r=0.240，p=0.030），小曲线Cobb角(r=0.256,p=0.020)和总曲线Cobb角(r=0.266,p=0.016)。支架前根尖椎体旋转和根尖椎体水平均与支架的旋转效应显着相关（p<0.001）。胸大曲患者表现出比腰椎大曲患者更差的旋转效应(p<0.001)。此外,冠状平衡的患者比冠状失代偿的患者表现出更好的支架内旋转效应(p=0.005)。
结论：AIS患者在支撑后立即可以获得令人满意的根尖椎体旋转率（约50％）。曲线的前支撑Cobb角，前托根尖椎体旋转，根尖椎骨水平和冠状平衡与根尖椎骨的支架内旋转效应密切相关。
方法：本研究纳入82名符合条件的患者，在支撑之前和之后立即接受了EOS成像评估。临床人口统计数据(年龄，性别,记录Riser体征和月经状态）。偏离效应与关键参数(年龄，前撑科布角,胸椎后凸,腰椎前凸,椎骨旋转,进行骨盆轴向旋转和根尖椎体水平）。按性别分层的内支撑偏差效应，Risser标志,顶椎水平，初潮状态，还分析了冠状平衡和矢状平衡。
结果：顶椎的旋转从支撑前的8.8±6.0度下降到支撑后立即的3.8±3.3度（p<0.001），降低率为49.2±38.3%。支具的旋转度与主要曲线Cobb角显着相关（r=0.240，p=0.030），小曲线Cobb角(r=0.256,p=0.020)和总曲线Cobb角(r=0.266,p=0.016)。支架前根尖椎体旋转和根尖椎体水平均与支架的旋转效应显着相关（p<0.001）。胸大曲患者表现出比腰椎大曲患者更差的旋转效应(p<0.001)。此外,冠状平衡的患者比冠状失代偿的患者表现出更好的支架内旋转效应(p=0.005)。
结论：AIS患者在支撑后立即可以获得令人满意的根尖椎体旋转率（约50％）。曲线的前支撑Cobb角，前托根尖椎体旋转，根尖椎骨水平和冠状平衡与根尖椎骨的支架内旋转效应密切相关。
