The Research Of Adolescent Idiopathic Scoliosis Trunk Imbalance And The Effect Of Rehabilitation Therapy

Objecttive: At present,the treatment of adolescent idiopathic scoliosis(AIS)focuses on how to reduce the Cobb angle,the problem of partial or overall trunk imbalance caused by scoliosis is often overlooked.This study focused on the coronal shoulder and pelvic imbalance in AIS,as well as changes in sagittal thoracic,lumbar curvature and pelvic position,summarizing coronal and sagittal trunk imbalance in patients with AIS.In this study,the changes of coronal and sagittal morphological indexes before and after rehabilitation therapy were observed,and the rehabilitation effect of AIS was also observed.Methods: 30 patients with AIS were enrolled according to inclusion criteria,and full-spine X-ray was taken before intervention.Cobb angle,Clavicle Angle(CA),Pelvic Obliquity(PO),Sacral Obliquity(SO),and Trunk Shift(TS)were measured on the anterior slice.Thoracic Kyphosis(TK),Lumbar Lordosis(LL),Pelvic Incidence(PI),Pelvic Tilt(PT),Sacral Slope(SS),Sagittal Vertical Axis(SVA)and T1 Pelvic Angel(TPA)were measured on the lateral slice.Subjects were divided into experimental group(n=14)and observation group(n=16)according to the patient's personal treatment willingness.After 6 months of rehabilitation therapy,all subjects took the second full-spine X-ray.The changes of parameters between groups before and after the experiment were compared,analyzing the rehabilitation effect of AIS.Results: 1.The shoulder imbalance rate was 66.67%,and the pelvic imbalance rate was 73.33%.The SO of patients with lumbar,thoracolumbar and double scoliosis was significantly larger than that of thoracic scoliosis(p <0.01).2.Cobb angle was positively correlated with SO(r=0.467,p <0.01).3.The trunk shift rate was 60%.94.4% of which,trunk shift direction was consistent with the scoliosis direction.The Cobb angle(p<0.05)and SO(p<0.01)of the trunk shift group were larger than the coronal balance group.4.The TK of AIS was lower than that of normal adolescents,TK was negatively correlated with Cobb angle(r=-0.606,p<0.01).The LL of thoracic and lumbar scoliosis was significantly reduced compared with the thoracolumbar scoliosis,double-scoliosis and normal populations(p<0.05).5.PI and SS were significantly increased in AIS(p<0.01),PT of thoracolumbar scoliosis was significantly reduced(p<0.05).6.The rate of spine imbalance is 66.67% and most patients show posterior tilt.7.After rehabilitation therapy,Cobb angle,CA,PO,SO significantly decreased(p <0.01),sagittal TPA significantly increased(p <0.01).The trunk shift rate decreased by 50% and the sagittal imbalance rate of spine decreased by 42.86%.Conclusions: 1.Most AIS have coronal shoulder and pelvic imbalance problems.Patients with larger Cobb angle and SO are more likely to be trunk shift,and the direction of trunk shift is greatly affected by the direction of scoliosis(main curve).2.The more severe the scoliosis,the more TK is reduced.Some patients LL reduce,while SO compensatory increase.Most AIS show anterior pelvic rotation and back leaning.3.After 5 months of rehabilitation,the Cobb angle decreased about 10° on average,and the correction of thoracic scoliosis was more difficult and took longer.4.Coronal shoulder and pelvic imbalance were significantly improved.Anterior pelvic rotation and back leaning were also improved,but TK and LL show less change.5.The rehabilitation therapy of spinal coronal deformity show more effect than sagittal plane.