Engsberg Jack R, Lenke Lawrence G, Reitenbach Angela K, Hollander Kevin W, Bridwell Keith H, Blanke Kathy
Human Performance Laboratory, Barnes-Jewish Hospital, Department of Orthopaedic Surgery, Washington University School of Medicine, Shrine Hospitals for Children, St. Louis Unit, St. Louis, Missouri, USA.
Spine (Phila Pa 1976). 2002 Jun 15;27(12):1346-54. doi: 10.1097/00007632-200206150-00018.
Prospective evaluation of spinal range of motion in patients with adolescent idiopathic scoliosis undergoing a spinal fusion.
Evaluate changes in triplanar spine range of motion following spinal fusion.
Preoperative and postoperative radiographs have been the major form of outcome analysis of adolescent idiopathic scoliosis fusions. Although the radiographs document static positions of the skeletal system, they do not document dynamic changes.
Thirty patients with adolescent idiopathic scoliosis undergoing an instrumented spinal fusion underwent triplanar range of motion tests before surgery and at 12 and 24 months after surgery. Videography with reflective surface markers was used to capture the motions. A fused region, unfused regions above and below the fusion, and a global spinal measure were used to assess changes.
Results indicated a loss of motion in the coronal and sagittal planes for the fused and unfused spinal regions and a loss of motion in the coronal, sagittal, and transverse planes for the global measurements. Results also indicated preoperative and continued postoperative right and left lateral flexion asymmetries. No significant correlations were found between the total fused levels and changes in range of motion. No significant correlations were found between the lowest instrumented vertebra and changes in range of motion.
Whereas range of motion was reduced in the fused regions of the spine, it was also reduced in unfused regions. The lack of compensatory increase in motion at unfused regions contradicts current theory and suggests early postoperative range of motion therapy to facilitate motion in unfused regions.
对接受脊柱融合术的青少年特发性脊柱侧凸患者的脊柱活动范围进行前瞻性评估。
评估脊柱融合术后三平面脊柱活动范围的变化。
术前和术后X线片一直是青少年特发性脊柱侧凸融合术结果分析的主要形式。尽管X线片记录了骨骼系统的静态位置，但它们并未记录动态变化。
30例接受器械辅助脊柱融合术的青少年特发性脊柱侧凸患者在手术前、术后12个月和24个月接受三平面活动范围测试。使用带有反光表面标记的摄像技术来捕捉运动。采用融合区域、融合上下未融合区域以及整体脊柱测量来评估变化。
结果表明，融合和未融合脊柱区域在冠状面和矢状面的活动度降低，整体测量在冠状面、矢状面和横断面上的活动度降低。结果还表明术前及术后持续存在左右侧屈不对称。融合节段总数与活动范围变化之间未发现显著相关性。最低固定椎体与活动范围变化之间未发现显著相关性。
虽然脊柱融合区域的活动范围减小，但未融合区域的活动范围也减小。未融合区域活动度缺乏代偿性增加与当前理论相悖，提示术后早期进行活动范围治疗以促进未融合区域的活动。
