学术论文

      EOS成像系统在脊柱矢状面畸形临床评估中的应用进展

      Review in clinical evaluation of EOS imaging system on spinal deformity along sagittal plane

      摘要:
      脊柱矢状面畸形常见于成人脊柱畸形、腰椎退行性变、强直性脊柱炎和脊柱结核等疾病,可引起患者躯体失平衡、心肺功能异常和腰背痛等临床相关症状.脊柱矢状面形态在脊柱畸形患者生存质量中所起作用越来越受到外科医生的关注.严重的脊柱矢状面畸形常伴随骨盆后旋、膝关节屈曲的改变,其只能通过外科手术进行矫正,而对患者矢状面序列的分析则是手术方案制定的基础.利用传统影像学技术,只能对脊柱矢状面序列进行相关分析.随着脊柱矢状面序列研究的不断进展,骨盆及下肢对脊柱畸形的代偿作用逐渐引起重视,对脊柱矢状面畸形患者行包括脊柱、骨盆和下肢的全身矢状面序列分析和不同体态下脊柱矢状面序列的动态分析显得越发重要.EOS成像系统通过对脊柱矢状面畸形患者进行全身序列和动态的影像分析极大地改变了这一现状.借鉴传统影像学参数的局限性,一些区别于以往的影像学参数被采用,其可更加全面地评估脊柱矢状面形态;配合患者不同的拍摄体态,EOS的动态影像分析和全身序列影像分析在脊柱矢状面畸形患者手术策略的制定和矫形术后的疗效评估中发挥了重要作用.回顾EOS成像系统在脊柱矢状面临床评估中的研究成果及应用进展,可使脊柱外科医生进一步认识脊柱序列,从而为脊柱矢状面畸形患者制定最佳手术方案.
      Abstract:
      Spinal sagittal deformity could be frequently observed in adult spinal scoliosis,lumbar degeneration,ankylosing spondylitis,spinal tuberculosis and other diseases.Patients with the spinal sagittal malalignment were often accompanied with sagittal imbalance,cardiopulmonary function abnormity and low back pain.The importance of spinal sagittal morphology in healthrelated quality of life has been suggested by more and more spinal surgeons.Pelvic backward rotation and knee flexion could be found in patients with severe spinal sagittal deformity.Surgery was essential for advanced stage of spinal sagittal deformity,and the analysis of sagittal alignment based on radiologic methods would be the indispensable part in determining surgical intervention.Sagittal alignment analysis was limited at spine using the conventional radiologic techniques.However,with the progress of study in spinal sagittal alignment,the significant roles of full-body sagittal alignment composed of spine,pelvic and sub-pelvic and dynamic differences in spinal sagittal alignment between various functional positions were being recognized in the evaluation of spinal sagittal alignment.So the evaluation of sagittal alignment would be limited by the conventional imaging.Fortunately,the awkward situation has been retrieved by the innovative EOS imaging system through which both of the full-body sagittal alignment and dynamic spinal sagittal alignment differences could be analyzed.Inspired by the limitation of conventional radiological parameters,a series of new parameters have been adopted to assess the severity of spinal sagittal malalignment.EOS has also been applied to surgical decision making and clinical outcome assessment.This review was to summarize the clinical evaluation of EOS imaging system on spinal deformity along sagittal plane.We hoped to provide new information regarding the global spinal sagittal alignment in different functional posture to improve the understanding of spinal sagittal alignment thereby the optimal surgical strategy could be performed.
      Author: Zhao Shizhou Qian Bangping Qiu Yong
      作者单位: 210008,南京大学医学院附属鼓楼医院脊柱外科
      刊 名: 中华骨科杂志 ISTICPKU
      年,卷(期): 2018, 38(19)
      Keywords: @@知识脉络
      在线出版日期: 2018年11月9日
      基金项目: 国家自然科学基金,National Natural Science Foundation of China