特发性脊柱侧凸King、Lenke和PUMC分型的可信度和可重复性研究
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摘要
目的:应用无标记的X线片评价特发性脊柱侧凸King、Lenke和PUMC分型的可信度和可重复性,为临床应用提供一定的参考。方法:四名骨科医师独立对56例患者的术前站立位全脊柱正、侧位和仰卧位左、右Bending位X线片进行测量并分型。通过计算平均百分比确定分型一致性,应用Kappa值判定可靠性和可重复性。结果:King分型具有极好的可重复性和中、高度的可信度。可重复性平均82.6%(Kappa值,0.767),可信度平均65.8%(Kappa值,0.542)。KingⅡ型和Ⅲ型侧凸判读是影响分型一致性最主要的原因。另一个重要的影响因素是KingⅤ型的判读。Lenke完整分型仅有较差的一致性,可重复性平均50.0%(Kappa值,0.438),可信度平均47.0%(Kappa值,0.402)。但Lenke分型各组成部分分别评价时,它们均取得了中、高度一致性。上胸弯是否结构性的判读以及矢状面修正型的分型是影响Lenke分型一致性的主要原因。PUMC三大型有极好的一致性,各亚型只有中、高度的一致性,可重复性平均74.1%(Kappa值,0.674),可信度平均70.2%(Kappa值,0.629)。侧凸的限定以及Cobb角的测量误差是影响PUMC分型一致性的重要原因。结论:三种分型均没有很好的解决上胸弯判读的争议,它仍然是影响三种分型一致性的重要原因。角度测量误差是导致Lenke和PUMC分型一致性较差的主要原因。临床工作中,应充分考虑到各种可能导致分型不一致的因素,在制定手术策略时应考虑到这些因素的影响。
Objective: To determine the reliability and reproducibility of the King, Lenke and PUMC classification systems for idiopathic scoliosis using radiographs that had not been premeasured. Methods: Preoperative radiographs (standing full-length posteroanterior, lateral and two supine side-bending radiographs) of 56 patients were evaluated by four orthopedic surgeons independently on two separate occasions. The results were determined by calculating the average percentage of intraobserver and interobserver agreement. Reliability and reproducibility was quantified using kappa statistics. Results: The King classification demonstrated good to excellent intraobserver reproducibility and fair interobserver reliability. The mean interobserver reliability was 65.8% (mean Kappa coefficient, 0.542), while intraobserver reproducibility was 82.6% (mean Kappa coefficient, 0.767). The main reason of disagreement was distinguishment of the King type II and type III. Another reason is assessment of King type V. All three parameters of the overall Lenke curve classification demonstrated poor reliability. The mean interobserver reliability was 50.0% (mean Kappa coefficient, 0.438), while intraobserver reproducibility was 47.0% (mean Kappa coefficient, 0.402). The three parameters had fair interobserver reliabilities and intraobserver reproducibilities when it was examined separately. The main reasons for disagreement arose from judging a structural upper thoracic curve and from assigning of sagittal thoracic modifier. The PUMC type demonstrated good to excellent intraobserver reproducibility and interobserver reliability, and the subtype demonstrated fair. The mean interobserver reliability was 70.2% (mean Kappa coefficient, 0.629), while intraobserver reproducibility was 74.1% (mean Kappa coefficient, 0.674). The main reasons for disagreement were definition of a curvature and Cobb angle measurements. Conclusion: This three classifications do not appear to eliminate the dispute for the definition of the upper thoracic curve. The main reason of lower reliability and reproducibility of the Lenke and PUMC classification systems can be attribute to the variable of Cobb angle measurements. Orthopedic surgeons should be think over the effect of the factors mentioned above, when make the surgical decisions.
Objective: To determine the reliability and reproducibility of the King, Lenke and PUMC classification systems for idiopathic scoliosis using radiographs that had not been premeasured. Methods: Preoperative radiographs (standing full-length posteroanterior, lateral and two supine side-bending radiographs) of 56 patients were evaluated by four orthopedic surgeons independently on two separate occasions. The results were determined by calculating the average percentage of intraobserver and interobserver agreement. Reliability and reproducibility was quantified using kappa statistics. Results: The King classification demonstrated good to excellent intraobserver reproducibility and fair interobserver reliability. The mean interobserver reliability was 65.8% (mean Kappa coefficient, 0.542), while intraobserver reproducibility was 82.6% (mean Kappa coefficient, 0.767). The main reason of disagreement was distinguishment of the King type II and type III. Another reason is assessment of King type V. All three parameters of the overall Lenke curve classification demonstrated poor reliability. The mean interobserver reliability was 50.0% (mean Kappa coefficient, 0.438), while intraobserver reproducibility was 47.0% (mean Kappa coefficient, 0.402). The three parameters had fair interobserver reliabilities and intraobserver reproducibilities when it was examined separately. The main reasons for disagreement arose from judging a structural upper thoracic curve and from assigning of sagittal thoracic modifier. The PUMC type demonstrated good to excellent intraobserver reproducibility and interobserver reliability, and the subtype demonstrated fair. The mean interobserver reliability was 70.2% (mean Kappa coefficient, 0.629), while intraobserver reproducibility was 74.1% (mean Kappa coefficient, 0.674). The main reasons for disagreement were definition of a curvature and Cobb angle measurements. Conclusion: This three classifications do not appear to eliminate the dispute for the definition of the upper thoracic curve. The main reason of lower reliability and reproducibility of the Lenke and PUMC classification systems can be attribute to the variable of Cobb angle measurements. Orthopedic surgeons should be think over the effect of the factors mentioned above, when make the surgical decisions.
引文
铩颷1]King HA,Moe JH,Bradford DS,et al.The selection of fusion levels in thoracicidiopathic scoliosis[J],J Bone Joint Surg(Am),1983,65(9):1302-1313.
[2]Cummings RG,Loveless EA,Campbell J,et al.Interobserver reliability andIntraobserver reproducibility of the system of King et al.for the classification ofadolescent idiopathic scoliosis[J].J Bone Joint Surg(Am),1998,80(8):1107-1111.
[3]Lenke LC,Betz RR,Bridwell KH,et al.Intraobserver and interobserver reliabilityof the classification of thoracic adolescent idiopathic scoliosis[J].J Bone Joint Surg(Am),1998,80(8):1097-1106.
[4]Mason DE,Carango P.Spinal decompensation in Cotrel-Dubousset instrumentation[J].Spine,1991;16(Suppl 8):S394-S403.
[5]Bridwell KH,McAllister.JW,Betz R.et al.Coronal decompensation produced byCotrel-Dubousset ″derotation″ maneuver for idiopathic right thoracic scoliosis[J].Spine,1991,16(7):769-777.
[6]Lenke LC,Bridwell KH,Baldus C,et al.Ability of Cotrel-Dudoussetinstrumentation to preserve distal lumbar motion segments in adolescent idiopathicscoliosis[J].J Spinal Disord,1993,6(4):339-350.
[7]Thompson JP.Decompensation after Cotrel-Dubousset instrumentation of idiopathicscoliosis[J].Spine,1990,15(9):927-931.
[8]Ibrahim K,Benson L.Cotrel-Dubousset instrumentation for double major rightthoracic left lumbar scoliosis,the relation between frontal balance,hookconfiguration and fusion level[J].Orthop Trans,1991,15:114.
[9]Lenke LG,Betz RR,Harms J,et al.Adolescent idiopathic scoliosis:a newclassification to determine extent of spinal arthrodesis[J].J Bone Joint Burg(Am),2001,83(8):1169-1181.
[10]Lenke LG,Edward CC,Bridwell KH,et al.The Lenke classification of Adolescentidiopathic scoliosis:How it organizes curve patterns as a template selective fusion ofthe spine[J].Spine,2003,28(20S):S199-S207.
[11]Puno RM,An KC,Puno RL,et al.Treatment recommendations for IdiopathicScoliosis:an assessment of the Lenke classification[J].Spine,2003,28(18):2102-2114.
[12]Dobbs MB,Lenke LG;Kim YJ,et al.Selective Posterior Thoracic Fusion forAdolescent Idiopathic Scoliosis:Comparision of Hooks Versus Pedicle Screws[J]. Spine,2006,31(20):2400-2404.
铩颷13]Cil A,Pekmezci M,Yazici M,et al.The validity of Lenke criteria for definingstructural proximal thoracic curves in patients with adolescent idiopathic scoliosis[J].Spine,2005,30(22):2550-2555.
[14]Ogon M,Ciesinger K,Behensky H,et al.Interobserver and intraobserver reliabilityof Lenke's new scoliosis classification system[J].Spine,2002,27(8):858-862.
[15]Richards BS,Sucato DJ,Konigsberg D E,et al.Comparison of reliability betweenthe Lenke and King classification systems for adolescent idiopathic scoliosis usingradiographs that were not premeasured[J].Spine,2003,28(11):1148-1157.
[16]邱贵兴,于斌,Norbert Ventura,等.特发性脊柱侧凸 King、Lenke 和 PUMC临床分型的应用比较[J].中华骨科杂志,2006,26(3):145-150.
[17]Lenke LG,Betz RR,Haher TR,et al.Multisurgeon assessment of surgicaldecision-making in adolescent idiopathic scoliosis:curve classification,operativeapproach,and fusion levels[J].Spine,2001,26(21):2347-2353.
[18]邱贵兴,仉建国,王以朋,等.特发性脊柱侧凸的PUMC(协和)分型系统[J].中华骨科杂志,2003,23(1):1-9.
[19]Guixing Qiu,Jianguo Zhang,Yipeng Wang,et al.A new operative classification ofidiopathic scoliosis:a Peking Union Medical College method[J].Spine,2005,30(12):1419-1426.
[20]华琳,阎岩,张建.关于对诊断一致性Kappa系统的探讨[J].数理医药学杂志,2006.19:518-520.
[21]Svanholm H,Starklint H,Gundersen HJG.et al.Reproducibility ofhistomorphologic diagnosis with special reference to the kappa statistic[J].APMIS,1989,97:689-698.
[22]Behensky H,Giesinger K,Ogon M,et al.Multisurgeon assessment of coronalpattern classification systems for adolescent idiopathic scoliosis:reliability and erroranalysis[J].Spine,2002,27:762-766.
[23]Niemeyer T,Wolf A,Kluba S,et al.Interobserver and intraobserver agreement ofLenke and King classification for idiopathic scoliosis and the influence of level ofprofessional training[J].Spine,2006,31:2103-2107.
[24]Kuklo TR,Potter BK,Polly DW,et al.Reliability analysis for manual adolescentidiopathic scoliosis measurements[J].Spine,2005,30:444-454.
[25]Dang NR,Moreau MJ,Hill DL,et al.Intra-observer reproducibility andinterobserver reliability of the radiographic parameters in the Spinal Deformity Study Group's AIS Radiographic Measurement Manual[J].Spine,2005,30:
1064-1069.
铩颷26]Feinstein AR,Cicchetti DV.High agreement but low Kappa:The problems of thetwo paradoxes[J].J Clin Epidemiol.1990,43:543-549.
[27]Winter RB,Denis F,The King type V cure pattern:its analysis and surgicaltreatment[J].Orthop Clin North Am,1994,25(2):353-362.
[28]Lee CK,Denis F,Winter RB,et al.Analysis of upper thorcic curve in surgicallytreated idiopathic scoliosis:a new concept of double thoracic curve patten[J].Spine,1993,18(12):1599-1608.
[29]Lenke LG,Bridwell KH,O'Brien MF,et al.Recongnition and treatment of theproximal thoracic curve in adolescent idiopathic scoliosis treated withCotrel-Dudousset instrumentation[J].Spine,1994,19(1):1589-1597.
[30]邱勇.特发性胸椎侧凸上胸弯的认定及其临床意义[J].中国脊柱脊髓杂志,2006,16(3);165-166.
[31]于斌,王以朋,邱贵兴.特发性脊柱侧凸患者上胸弯的识别和处理[J].中华骨科杂志,2006,26(5):343-345.
[32]Kuklo TR,Lenke LG,Graham FJ,et al.Correlation of radiographic,clinical,andpatient assessment of shoulder balance following fusion versus nonfusion of theproximal thoracic curve in adolescent idiopathic scoliosie[J].Spine,2002(18),27:2013-2020.
[33]Potter BK,Rosner MK,Lehman RA,et al.Reliability of end,neutral,and stablevertebrae identification in adolescent idiopathic scoliosis[J].Spine,2005,30:1658-1663.
[34]Mior SA,Kopansky-Giles DR,Crowther ER,et al.A comparison of radiographicelectrogoniometrie angles in adolescent idiopathic scoliosis[J].Spine.1996,21:1549-1555.
铩颷1]King HA,Moe JH,Bradford DS,et al.The selection of fusion levels in thoracicidiopathic scoliosis[J].J Bone Joint Surg(Am),1983,65(9):1302-1313.
[2]Lenke LC,Bridwell KH,Baldus C,et al.Ability of Cotrel-Dudoussetinstrumentation to preserve distal lumbar motion segments in adolescent idiopathicscoliosis[J].J Spinal Disord,1993,6(4):339-350.
[3]Cummings RG,Loveless EA,Campbell J,et al.Interobserver reliability andIntraobserver reproducibility of the system of King et al.for the classification ofadolescent idiopathic scoliosis[J].J Bone Joint Surg(Am),1998,80(8):1107-1111.
[4]Lenke LC,Betz RR,Bridwell KH,et al.Intraobserver and interobserver reliabilityof the classification of thoracic adolescent idiopathic scoliosis[J].J Bone Joint Surg(Am),1998,80(8):1097-1106.
[5]Lee CK,Denis F,Winter RB,et al.Analysis of upper thorcic curve in surgicallytreated idiopathic seoliosis:a new concept of double thoracic curve patten[J].Spine,1993,18(12):1599-1608.
[6]Winter RB,Denis F.The King type V cure pattern:its analysis and surgicaltreatment[J].Orthop Clin North Am,1994,25(2):353-362.
[7]Lenke LG,Bridwell KH,O'Brien MF,et al.Recongnition and treatment of theproximal thoracic curve in adolescent idiopathic scoliosis treated withCotrel-Dudousset instrumentation[J].Spine,1994,19(1):1589-1597.
[8]邱勇.特发性胸椎侧凸上胸弯的认定及其临床意义[J].中国脊柱脊髓杂志,2006,16(3);165-166.
[9]Mason DE,Carango P.Spinal decompensation in Cotrel-Duboussetinstrumentation[J].Spine,1991;16(Suppl 8):S394-S403.
[10]Bridwell KH,McAllister JW,Betz R.et al.Coronal decompensation produced byCotrel-Dubousset "derotation" maneuver for idiopathic right thoracic scoliosis[J].Spine,1991,16(7):769-777.
[11]Lenke LG.Bridwell KH,Baldus C,et al.Preventing decompensation in King typeⅡ curves treated with Cotrel-Dubousset instrumentation:strict guidelines forselective thoracic fusion[J].Spine,1992,17(8 suppl):274-281.
[12]Thompson JP.Decompensation after Cotrel-Dubousset instrumentation of idiopathicscoliosis[J].Spine,1990,15(9):927-931.
[13]Ibrahim K,Benson L.Cotrel-Dubousset instrumentation for double major right thoracic left lumbar scoliosis,the relation between frontal balance,hook
configuration and fusion level[J].Orthop Trans,1991,15:114.
铩颷14]Asher MA,Burton DC.A concept of idiopathic scoliosis deformities as imperfecttorsion(s),clin Orthop,1999,(364):11-25.
[15]Lenkc LG,Betz RR,Harms J,et al.Adolescent idiopathic scoliosis:a newclassification to determine extent of spinal arthrodesis[J].J Bone Joint Burg(Am),2001,83(8):1169-1181.
[16]Lenke LG,Edward CC,Bridwell KH,et al.The Lenke classification of Adolescentidiopathic scoliosis:How it organizes curve patterns as a template selective fusion ofthe spine[J].Spine,2003,28(20S):S199-S207.
[17]Puno RM,An KC,Puno RL,et al.Treatment recommendations for IdiopathicScoliosis:an assessment of the Lenke classification[J].Spine,2003,28(18):2102-2114.
[18]Dobbs MB,Lenke LG,Kim YJ,et al.Selective Posterior Thoracic Fusion forAdolescent Idiopathic Scoliosis:Comparision of Hooks Versus Pedicle Screws[J].Spine,2006,31(20):2400-2404.
[19]Cil A,Pekmezci M,Yazici M,et al.The validity of Lenke criteria for definingstructural proximal thoracic curves in patients with adolescent idiopathic scoliosis[J].Spine,2005,30(22):2550-2555.
[20]邱贵兴,于斌,Norbert Ventura,等.特发性脊柱侧凸 King、Lenke和PUMC临床分型的应用比较[J].中华骨科杂志,2006,26(3):145-150.
[21]Ogon M,Ciesinger K,Behensky H,et al.Interobserver and intraobserver reliabilityof Lenke's new scoliosis classification system[J].Spine,2002,27(8):858-862.
[22]Richards BS,Sucato DJ,Konigsberg D E et al.Comparison of reliability betweenthe Lenke and King classification systems for adolescent idiopathic scoliosis usingradiographs that were not premeasured[J].Spine,2003,28(11):1148-1157.
[23]Lenke LG,Betz RR,Haher TR,et al.Multisurgeon assessment of surgicaldecision-making in adolescent idiopathic scoliosis:curve classification,operativeapproach,and fusion level s[J].Spine,2001,26(21):2347-2353.
[24]Kuklo TR,Lenke LG,Graham FJ,et al.Correlation of radiographic,clinical,andpatient assessment of shoulder balance following fusion versus nonfusion of theproximal thoracic curve in adolescent idiopathic scoliosie[J].Spine,2002(18),27:2013-2020.
[25]邱贵兴,仉建国,王以朋,等.特发性脊柱侧凸的PUMC(协和)分型系统[J]. 中华骨科杂志,2003,23(1):1-9.
铩颷26]Guixing Qiu,Jianguo Zhang,Yipeng Wang,et al.a new operative classification ofidiopathic scoliosis:a Peking Union Medical College method[J].Spine,2005,30(12):1419-1426.
[27]于斌,王以朋,邱贵兴.特发性脊柱侧凸患者上胸弯的识别和处理[J].中华骨科杂志,2006,26(5):343-345.
[2]Cummings RG,Loveless EA,Campbell J,et al.Interobserver reliability andIntraobserver reproducibility of the system of King et al.for the classification ofadolescent idiopathic scoliosis[J].J Bone Joint Surg(Am),1998,80(8):1107-1111.
[3]Lenke LC,Betz RR,Bridwell KH,et al.Intraobserver and interobserver reliabilityof the classification of thoracic adolescent idiopathic scoliosis[J].J Bone Joint Surg(Am),1998,80(8):1097-1106.
[4]Mason DE,Carango P.Spinal decompensation in Cotrel-Dubousset instrumentation[J].Spine,1991;16(Suppl 8):S394-S403.
[5]Bridwell KH,McAllister.JW,Betz R.et al.Coronal decompensation produced byCotrel-Dubousset ″derotation″ maneuver for idiopathic right thoracic scoliosis[J].Spine,1991,16(7):769-777.
[6]Lenke LC,Bridwell KH,Baldus C,et al.Ability of Cotrel-Dudoussetinstrumentation to preserve distal lumbar motion segments in adolescent idiopathicscoliosis[J].J Spinal Disord,1993,6(4):339-350.
[7]Thompson JP.Decompensation after Cotrel-Dubousset instrumentation of idiopathicscoliosis[J].Spine,1990,15(9):927-931.
[8]Ibrahim K,Benson L.Cotrel-Dubousset instrumentation for double major rightthoracic left lumbar scoliosis,the relation between frontal balance,hookconfiguration and fusion level[J].Orthop Trans,1991,15:114.
[9]Lenke LG,Betz RR,Harms J,et al.Adolescent idiopathic scoliosis:a newclassification to determine extent of spinal arthrodesis[J].J Bone Joint Burg(Am),2001,83(8):1169-1181.
[10]Lenke LG,Edward CC,Bridwell KH,et al.The Lenke classification of Adolescentidiopathic scoliosis:How it organizes curve patterns as a template selective fusion ofthe spine[J].Spine,2003,28(20S):S199-S207.
[11]Puno RM,An KC,Puno RL,et al.Treatment recommendations for IdiopathicScoliosis:an assessment of the Lenke classification[J].Spine,2003,28(18):2102-2114.
[12]Dobbs MB,Lenke LG;Kim YJ,et al.Selective Posterior Thoracic Fusion forAdolescent Idiopathic Scoliosis:Comparision of Hooks Versus Pedicle Screws[J]. Spine,2006,31(20):2400-2404.
铩颷13]Cil A,Pekmezci M,Yazici M,et al.The validity of Lenke criteria for definingstructural proximal thoracic curves in patients with adolescent idiopathic scoliosis[J].Spine,2005,30(22):2550-2555.
[14]Ogon M,Ciesinger K,Behensky H,et al.Interobserver and intraobserver reliabilityof Lenke's new scoliosis classification system[J].Spine,2002,27(8):858-862.
[15]Richards BS,Sucato DJ,Konigsberg D E,et al.Comparison of reliability betweenthe Lenke and King classification systems for adolescent idiopathic scoliosis usingradiographs that were not premeasured[J].Spine,2003,28(11):1148-1157.
[16]邱贵兴,于斌,Norbert Ventura,等.特发性脊柱侧凸 King、Lenke 和 PUMC临床分型的应用比较[J].中华骨科杂志,2006,26(3):145-150.
[17]Lenke LG,Betz RR,Haher TR,et al.Multisurgeon assessment of surgicaldecision-making in adolescent idiopathic scoliosis:curve classification,operativeapproach,and fusion levels[J].Spine,2001,26(21):2347-2353.
[18]邱贵兴,仉建国,王以朋,等.特发性脊柱侧凸的PUMC(协和)分型系统[J].中华骨科杂志,2003,23(1):1-9.
[19]Guixing Qiu,Jianguo Zhang,Yipeng Wang,et al.A new operative classification ofidiopathic scoliosis:a Peking Union Medical College method[J].Spine,2005,30(12):1419-1426.
[20]华琳,阎岩,张建.关于对诊断一致性Kappa系统的探讨[J].数理医药学杂志,2006.19:518-520.
[21]Svanholm H,Starklint H,Gundersen HJG.et al.Reproducibility ofhistomorphologic diagnosis with special reference to the kappa statistic[J].APMIS,1989,97:689-698.
[22]Behensky H,Giesinger K,Ogon M,et al.Multisurgeon assessment of coronalpattern classification systems for adolescent idiopathic scoliosis:reliability and erroranalysis[J].Spine,2002,27:762-766.
[23]Niemeyer T,Wolf A,Kluba S,et al.Interobserver and intraobserver agreement ofLenke and King classification for idiopathic scoliosis and the influence of level ofprofessional training[J].Spine,2006,31:2103-2107.
[24]Kuklo TR,Potter BK,Polly DW,et al.Reliability analysis for manual adolescentidiopathic scoliosis measurements[J].Spine,2005,30:444-454.
[25]Dang NR,Moreau MJ,Hill DL,et al.Intra-observer reproducibility andinterobserver reliability of the radiographic parameters in the Spinal Deformity Study Group's AIS Radiographic Measurement Manual[J].Spine,2005,30:
1064-1069.
铩颷26]Feinstein AR,Cicchetti DV.High agreement but low Kappa:The problems of thetwo paradoxes[J].J Clin Epidemiol.1990,43:543-549.
[27]Winter RB,Denis F,The King type V cure pattern:its analysis and surgicaltreatment[J].Orthop Clin North Am,1994,25(2):353-362.
[28]Lee CK,Denis F,Winter RB,et al.Analysis of upper thorcic curve in surgicallytreated idiopathic scoliosis:a new concept of double thoracic curve patten[J].Spine,1993,18(12):1599-1608.
[29]Lenke LG,Bridwell KH,O'Brien MF,et al.Recongnition and treatment of theproximal thoracic curve in adolescent idiopathic scoliosis treated withCotrel-Dudousset instrumentation[J].Spine,1994,19(1):1589-1597.
[30]邱勇.特发性胸椎侧凸上胸弯的认定及其临床意义[J].中国脊柱脊髓杂志,2006,16(3);165-166.
[31]于斌,王以朋,邱贵兴.特发性脊柱侧凸患者上胸弯的识别和处理[J].中华骨科杂志,2006,26(5):343-345.
[32]Kuklo TR,Lenke LG,Graham FJ,et al.Correlation of radiographic,clinical,andpatient assessment of shoulder balance following fusion versus nonfusion of theproximal thoracic curve in adolescent idiopathic scoliosie[J].Spine,2002(18),27:2013-2020.
[33]Potter BK,Rosner MK,Lehman RA,et al.Reliability of end,neutral,and stablevertebrae identification in adolescent idiopathic scoliosis[J].Spine,2005,30:1658-1663.
[34]Mior SA,Kopansky-Giles DR,Crowther ER,et al.A comparison of radiographicelectrogoniometrie angles in adolescent idiopathic scoliosis[J].Spine.1996,21:1549-1555.
铩颷1]King HA,Moe JH,Bradford DS,et al.The selection of fusion levels in thoracicidiopathic scoliosis[J].J Bone Joint Surg(Am),1983,65(9):1302-1313.
[2]Lenke LC,Bridwell KH,Baldus C,et al.Ability of Cotrel-Dudoussetinstrumentation to preserve distal lumbar motion segments in adolescent idiopathicscoliosis[J].J Spinal Disord,1993,6(4):339-350.
[3]Cummings RG,Loveless EA,Campbell J,et al.Interobserver reliability andIntraobserver reproducibility of the system of King et al.for the classification ofadolescent idiopathic scoliosis[J].J Bone Joint Surg(Am),1998,80(8):1107-1111.
[4]Lenke LC,Betz RR,Bridwell KH,et al.Intraobserver and interobserver reliabilityof the classification of thoracic adolescent idiopathic scoliosis[J].J Bone Joint Surg(Am),1998,80(8):1097-1106.
[5]Lee CK,Denis F,Winter RB,et al.Analysis of upper thorcic curve in surgicallytreated idiopathic seoliosis:a new concept of double thoracic curve patten[J].Spine,1993,18(12):1599-1608.
[6]Winter RB,Denis F.The King type V cure pattern:its analysis and surgicaltreatment[J].Orthop Clin North Am,1994,25(2):353-362.
[7]Lenke LG,Bridwell KH,O'Brien MF,et al.Recongnition and treatment of theproximal thoracic curve in adolescent idiopathic scoliosis treated withCotrel-Dudousset instrumentation[J].Spine,1994,19(1):1589-1597.
[8]邱勇.特发性胸椎侧凸上胸弯的认定及其临床意义[J].中国脊柱脊髓杂志,2006,16(3);165-166.
[9]Mason DE,Carango P.Spinal decompensation in Cotrel-Duboussetinstrumentation[J].Spine,1991;16(Suppl 8):S394-S403.
[10]Bridwell KH,McAllister JW,Betz R.et al.Coronal decompensation produced byCotrel-Dubousset "derotation" maneuver for idiopathic right thoracic scoliosis[J].Spine,1991,16(7):769-777.
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