女性青少年特发性脊柱侧凸颈椎形态对康复疗效的影响

关键词：青少年特发性脊柱侧凸  颈椎矢状面形态  Cobb角

Keywords:adolescent idiopathic scoliosis  cervical sagittal alignment  Cobb angle

摘要：

      摘要 目的：观察女性青少年特发性脊柱侧凸（adolescent idiopathic scoliosis， AIS）颈椎矢状面形态特征与康复治疗后Cobb角的变化，分析不同颈椎分型对康复治疗疗效的影响，研究颈椎形态在脊柱侧凸康复治疗中的作用。 方法：回顾性分析2016年1月—2021年12月于上海新华医院康复医学科随访的67例女性AIS的基本信息及站立位全脊柱X线片，测量其颈椎前凸角、颈椎矢状面形态、康复治疗前后的冠状面 Cobb 角，计算Cobb角改变量。根据颈椎矢状面形态，将患者分为颈椎前凸组和颈椎后凸组，比较两组患者康复治疗后Cobb角的变化量。以康复治疗后Cobb角变化量为因变量，女性AIS患者治疗前年龄、身高、体重、颈椎后凸为自变量，进行多元线性回归分析，研究颈椎后凸与康复治疗后Cobb角变化量的关系。 结果：67例女性AIS中47例（70.1%）存在颈椎后凸。康复治疗后，颈椎前凸组与颈椎后凸组的Cobb角改变量分别为﹣16.4°（﹣28.5°，﹣9.2°）、4.3°（﹣2.1°，9.0°），颈椎前凸组的Cobb角改变量较颈椎后凸组小，有显著性差异（P＜0.05）。线性回归结果表明颈椎后凸、身高是康复治疗后Cobb角变化量的影响因素（b=0.329，b=﹣0.440，P＜0.05）。 结论：女性青少年特发性脊柱侧凸多存在颈椎后凸，这种改变不利于生长发育期通过康复改善脊椎畸形角度，这可能与人体生物力学的结构，侧凸患者本体感觉受损相关。在特发性脊柱侧凸的康复治疗中，建议加强对颈椎矢状面形态的评估，针对性进行姿势管理和居家康复指导，从而提高康复治疗疗效。

Abstract:

      Abstract Objective： To observe the cervical sagittal plane morphological characteristics of female adolescent idiopathic scoliosis（AIS） and the change of Cobb angle after rehabilitation treatment， analyze the influence of different cervical spine types on the curative effect of rehabilitation treatment， and study the role of cervical spine morphology in the rehabilitation treatment of scoliosis. Method： A retrospective analysis was conducted on the basic information and standing spine radiography of 67 female patients with AIS who were followed up in the Department of Rehabilitation Medicine of Shanghai Xinhua Hospital from January 2016 to December 2021. Coronal Cobb angle， cervical lordosis （CL） before and after rehabilitation were measured. Cobb angle change was calculated. Patients with adolescent idiopathic scoliosis were divided into cervical lordosis group and cervical kyphosis group according to the CL of female AIS patients at the first diagnosis， and the change of Cobb angle after rehabilitation was compared between the two groups. Result： Cervical kyphosis was present in 47 （70.1%） of 67 female patients with AIS. After rehabilitation， the Cobb angle change in the lordosis group or the kyphosis group was ﹣16.4° （﹣28.5°，﹣9.2°） or 4.3°（﹣2.1°， 9.0°）， respectively. The Cobb angle change in the lordosis group was smaller than that in the kyphosis group， and the difference was statistically significant （P<0.05）. With the change of Cobb angle after rehabilitation treatment as the dependent variable，and the age，height，weight and cervical kyphosis of patients as independent variables，multiple linear regression analysis was conducted， and the results showed that cervical kyphosis and height were the influencing factors of the change of Cobb angle after rehabilitation treatment （b=0.329， b=﹣0.440， P<0.05）. Conclusion： Cervical kyphosis is common in female adolescent idiopathic scoliosis， and this change is not conducive in improving Cobb angle of spinal deformity through rehabilitation during growth and development， which may be related to the structure of human biomechanics and the damage of proprioception. To improve the curative effect of rehabilitation， it is recommended to strengthen the evaluation of cervical sagittal morphology， target postural management and home rehabilitation guidance in idiopathic scoliosis.