| BackgroudCongenital spinal deformities are caused by the abnormal development of the embryonic mesoderm in 4?6 weeks of pregnancy,and its incidence is about 1‰.Congenital spinal deformities can lead to asymmetric growth of the spine,resulting in scoliosis,kyphosis and other manifestations.Congenital deformity of the spine is usually classified into three types:failure of segmentation,formation,or a mixed form.Hemivertebra malformation is one of the most common congenital spinal deformities.Hemivertebral deformity can be divided into three types:fully segmented hemivertebra(65%),partially segmented hemivertebra(22%),and unsegmented hemivertebra(13%).Scoliosis and kyphosis can progress with age,and in severe cases can lead to disability.Not only the daily activities of patients are affected,but also the mental health of patients.Early diagnosis and treatment are particularly important.Congenital spinal deformities can be found in the fetal stage and is often diagnosed by ultrasound or MRI.After birth,the first choice is the full spine X-ray to follow up and evaluate.When unable to stand,X-ray,CT,MRI examinations are usually used in the supine position.Occasionally,patients with unequal length of lower limbs were examined by a seated full spine X-ray.The accepted gold standard for diagnosing scoliosis is standing posterior and anterior full spine X-ray.For patients who cannot stand,a supine full spine X-ray is usually used.Previous literature has reported that due to the influence of gravity,the Cobb angle in the supine position of idiopathic scoliosis is 7°?10°smaller than that in the standing position.The error of scoliosis angle of about 10° will affect the diagnosis of the disease,the determination of preoperative surgical plan and the follow-up of postoperative patients.At present,there are no studies on the changes of spinal curve in different positions of children with congenital spinal deformities.Whether congenital scoliosis is also affected by position is unknown.The influencing factors of complete segmental hemivertebral deformity are simple,and the incidence of complete segmental hemivertebral deformity is the highest.Therefore,it is easy to ensure the number of cases and reduce the influence of different types on the spinal curve by selecting scoliosis with complete segmental hemivertebral as the research object.PurposeTo investigate the effects of full spine X-ray in different positions on the angles of congenital spinal deformities in children.MethodsCollect the clinical data of 15 patients with complete segmental hemivertebral deformity from January 2018 to August 2019 in our hospital.In strict accordance with the inclusion and exclusion criteria,the eligible patients were included in the group,and their clinical data were collected and sorted out.The statistical data included age,sex,hemivertebra position,standing full spine X-ray,sitting full spine X-ray,supine full spine X-ray.The coronal images were measured in three positions,including segmental curvature angle,main curvature angle,proximal compensation angle,distal compensation angle,coronal balance.The data collected for sagittal images included:kyphotic angle of hemivertebra segment,the angle of thoracic kyphosis,the angle of thoracolumbar kyphosis,the angle of lumbar kyphosis,sagittal balance.The images were measured twice by experienced orthopedic surgeons.Pearson correlation analysis was used to investigate the correlation between the segmental curvature angle,main curvature angle,proximal compensation angle,distal compensation angle,sum of compensation angles in the coronal images of spinal curves in standing,sitting and supine positions.Data model is used to fit the correlation data,and the fitting effect is evaluated.The difference of coronal images in standing,sitting and supine position of segmental curvature angle,main curvature angle,proximal compensation angle,distal compensation angle,coronal balance were studied by using the random area group difference analysis or rank sum test.The difference between the three lateral positions of standing,sitting and supine position in the full spine X-ray was studied by using the analysis of random area group or rank sum test in kyphotic angle of hemivertebra segment,the angle of thoracic kyphosis,the angle of thoracolumbar kyphosis,the angle of lumbar kyphosis and sagittal balance.SPSS 21.0 software was used to process the measured data.Take ?=0.05 as the test level.ResultsIn this study,from January 2018 to August 2019,a total of 15 patients with completely segmented hemivertebra deformity were enrolled,including 5 males and 10 females aged 1-13 years,11 thoracic hemivertebra patients and 4 lumbar hemivertebra patients.The mean angle of segmental curvature in the three positions of the full spine X-ray in the patients with complete segmental hemivertebra deformity was 40.27°±7.55°,40.33°±8.23°,40.20°±8.28°,respectively.Average angle of main curvature angle was 35.33°±9.29°,35.53°±8.71°,26.27°±9.76°,respectively.Average angle of proximal compensation was 16.73°±8.11°,17.60°±7.70°,15.20°±7.64°,respectively.Average angle of distal compensation was 21.27°±7.09°,22.40°±6.52°,18.47°±8.28°,respectively.The coronal balance of the three positions was 5.8mm±4.4mm,9.1mm±7.0mm,21.3mm±9.9mm,respectively.In the three positions of standing position,sitting position and supine position,the kyphotic angle of hemivertebra segment in the X-ray lateral radiograph of the full spine was 21.67°±13.65°,22.07°± 14.01°,22.80°± 16.05°,respectively.The angle of thoracic kyphosis was 25.93°±14.09°,23.53°±12.99°,21.53°± 14.50°,respectively.The angle of thoracolumbar kyphosis was 17.33°± 14.73°,20.67°±11.64°,16.00°±13.07°,respectively.The angle of lumbar kyphosis was 33.47°±12.75°,26.93°±16.56°,35.33°± 18.83°,respectively.The sagittal balance was 32.7mm±22.3mm,32.1mm±15.8mm,25.1mm±16.3mm,respectively.The P-P diagram shows that the data of each group are in normal distribution.P earson correlation analysis results showed that the sum of proximal and distal compensatory angles of sitting full spine X-ray images was significantly correlated with segmental curvature angle at the level of 0.05 and showed a linear correlation.The sum of proximal and distal compensatory angles of supine full spine X-ray images was significantly correlated with segmental curvature angle at the level of 0.05 and showed a linear correlation.The result of homogeneity test of variance indicates that the data of segmental curvature angle,main curvature angle,proximal compensation angle,distal compensation angle,Sum of compensation angles are homogeneous.The results of variance analysis of random area group design indicated that there was no statistically significant difference between segmental curvature angle,proximal compensation angle,distal compensation angle.There was no statistically significant difference between standing position and sitting position in the main curvature angle,while the difference between standing position and supine position in the main curvature angle was statistically significant(p<0.05)and linearly correlated.The difference of the angle of the main curvature between the sitting position and the supine position was statistically significant(p<0.05)and showed a linear correlation.The variance of coronal balance was not uniform.The rank sum test showed that the difference of coronal balance between the three positions of standing position,sitting position and supine position was statistically significant(p<0.05).Results of lateral X-ray of the full spine in the standing,sitting and supine position.The result of homogeneity test of variance indicates that the data of kyphotic angle of hemivertebra segment,the angle of thoracic kyphosis,the angle of thoracolumbar kyphosis,the angle of lumbar kyphosis,sagittal balance are homogeneous.The results of variance analysis of random area group design indicated that there was no statistically significant difference between skyphotic angle of hemivertebra segment,the angle of thoracic kyphosis,the angle of thoracolumbar kyphosis,the angle of lumbar kyphosis(p<0.05).ConclusionsThe degree of segmental curvature of congenital spinal deformities can truly reflect the influence of hemivertebra on the spine,and it does not accept the influence of gravity on the position change,which provides an objective basis for early follow-up,treatment and evaluation. |
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