Effect Of Posterior Spinal Orthopedic Surgery In Lenke Type 1 Female AIS Patients On Breast Asymmetry

OBJECTIVE:To investigate the effect of posterior spinal orthopedic surgery on breast symmetry in female adolescent idiopathic scoliosis（AIS）and to determine the relationship between breast asymmetry and spinal deformity.METHODS:A total of 63 surgically treated female adolescent with right-thoracic AIS in our hospital from 2013 to 2017 were enrolled in this study.They were classified as Lenke type I with an average Cobb angle of 51.00±5.27 degrees and an age of 15.17±2.56.Preoperative patients underwent full-length positive lateral radiographs of the spine and full-length CT scan of the spine and breast appearance.Image J software was used to calculate the breast volume（BV）on both sides of the patient’s bump;and the breast shape on both sides of the bump was measured on CT.Imaging parameters,including camber（EA）,coverage angle（CA）,axial breast height（ABH）,and Sternum-nipple length NSD;and measuring the nipple line on the appearance（Clavicle-Nipple length CNL）,milk inner diameter（MR）and inferior breast radius IR.Measurements of spinal deformity parameters included Cobb angle,RAsag（RAsag）,and thoracoplasty.Paired t-test was performed to analyze the asymmetry changes of breast shape before and after surgery,and typical correlation analysis was used to determine the correlation between breast asymmetry change and general parameters and spinal deformity parameters,and multiple linear regression analysis was applied.The degree of correlation between them.RESULTS:The asymmetry of preoperative BV,ABH,NSD,EA,CA,CNL,MR,and IR were-49.6±63.5ml,-5.9±7.2mm,-2.1±10.5mm,and-3.4±3.6 degrees,respectively.14.6±9.7 degrees,-20.5±24.8mm,-6.4±7.8mm,among which BV,ABH,EA,CA,CNL,MR,IR showed significant asymmetry difference on the concave and convex side（P<0.05）;postoperative BV,ABH,NSD,EA,CA,CNL,MR,IR,the degree of asymmetry of the concave and convex side are-5.2±43.7mm,-0.2±5.2mm,-2.2±10.2mm,-1.1±3.4 degrees,7.5±8.5 degrees,-7.9 There were significant asymmetry differences between the±16.3mm and-2.0±6.9mm CA,CNL and MR concavities（P<0.05）.There was no significant difference in the degree of asymmetry between the NSD and the concavity before and after surgery（P>0.05）.Paired t-test showed that the degree of postoperative asymmetry of BV,ABH,NSD,EA,CA,CNL,MR,IR was significantly improved（P<0.05）,and the degree of asymmetry after SNNL was aggravated,but there was no statistical difference（P>0.05）.The typical correlation analysis shows that there is a certain correlation between the degree of breast asymmetry change and the general parametersandspinaldeformityparameters,andtheexpression is?_B（28）^A（28）-.⁰₀₈._96ΔBV-0^{543Y（10）0.42}._079A^H（10）0._-¹._0214B-0^{48W（10）0.51}._451C-0^{ΔCobb（10）}.₃⁰.^129ΔR_62D（10）.^Asag_0056E-.0042F（R=0.769,P<0.001）.Multiple linear regression analysis indicated that there was a significant linear correlation between age andΔBV andΔCNL（R²=0.401,P<0.05）;there was a significant linear correlation between Cobb angle correction rate andΔBV,ΔIR（R²=0.173,P<0.05）;whether there is a significant linear correlation between thoracoplasty andΔCNL,ΔIR（R²=0.231,P<0.05）;Conclusion:The incidence of BA in AIS is significant.The concave side breast is larger,more outward,and more concentrated than the convex side breast（EA large ABH large CA small）,and found that the developmental potential of the concave side of the breast is significantly lower than the convex side of the breast.Posterior spinal orthopedic surgery improves the asymmetry of the breast in the right thoracic female AlS patient during the development of the spinal deformity.The degree of asymmetry of the breast volume and the height of the breast axis and the camber of the breast camber before surgery were significantly improved after surgery,which further improved the overall asymmetry of the breast.And this improvement in the degree of breast asymmetry is closely related to the improvement in the degree of spinal deformity.