Standardization of dynamic RX for preoperative planning in adolescent idiopathic scoliosis

OBJECTIVE: To compare X-rays usually performed in supine with lateralization with those in lateral decubitus with fulcrum at the apex of the primary curve caused by cushion, in order to monitor the achievement of improvement patterns of correction in preestablished deformities for the preoperative surgical planning. METHODS: Comparison of radiographic studies in the preoperative supine with lateralization and lateral decubitus with cushion performing fulcrum at the apex of the major curve in patients with adolescent idiopathic scoliosis. RESULTS: Curves varied in AP between 76° e 40° and were corrected in supine with lateralization to the average of 21° observing that when carried out with fulcrum with cushion in lateral decubitus the curves were corrected to 15° on average with higher discrepancy in values among the most rigid curves. CONCLUSIONS: It was verified that on flexible curves the cushions did not produce satisfactory corrections in primary curves. In more rigid curves and in collaborative patients, greater effectiveness on the correction of deformity in main curves was obtained with cushions producing local fulcrum for a better preoperative planning on correction of deformities.

【研究目的】对比常规侧移仰卧位X线片与以衬垫在主弯顶点作为支点的侧卧位X线片，旨在监测既定畸形的矫正改善模式的达成情况，为术前手术规划提供依据。
【研究方法】纳入青少年特发性脊柱侧凸（adolescent idiopathic scoliosis）患者，对比其术前侧移仰卧位及以衬垫在主弯顶点作为支点的侧卧位影像学检查结果。
【研究结果】患者主弯前后位Cobb角范围为40°至76°；侧移仰卧位下矫正至平均21°，而采用衬垫作为支点的侧卧位检查中，主弯平均矫正至15°，且在僵硬程度较高的弯度中，矫正值差异更为显著。
【研究结论】本研究证实，对于柔韧性较好的弯度，以衬垫作为支点无法实现主弯的满意矫正；而在僵硬程度较高的弯度及依从性良好的患者中，采用衬垫构建局部支点可显著提升主弯畸形的矫正效果，为畸形矫正的术前规划提供更优参考。