Department of Orthopedics, Korea University Ansan Hospital, Ansan, South Korea.
Eur Spine J. 2013 Jun;22(6):1273-85. doi: 10.1007/s00586-013-2697-5. Epub 2013 Mar 1.
To identify factors that can affect postoperative shoulder balance in AIS.
89 adolescent idiopathic scoliosis patients with six types of curvatures who underwent surgery were included in this study. Whole spine antero-posterior and lateral radiographs were obtained pre- and postoperatively. In radiograms, shape and changes in curvatures were analyzed. In addition, four shoulder parameters and coronal balance were analyzed in an effort to identify factors significantly related to postoperative shoulder balance.
In general, all the four shoulder parameters (CHD, CA, CRID, RSH) were slightly increased at final follow up (t test, P < 0.05), although there was a decrease in Lenke type II and IV curvatures. However, pre- and postoperative shoulder parameters were not significantly different between each curvature types (ANOVA, P > 0.05). Moreover, no significant differences of pre- and postoperative shoulder level between different level of proximal fusion groups (ANOVA, P > 0.05) existed. In the analysis of coronal curvature changes, no difference was observed in every individual coronal curvatures between improved shoulder balance and aggravated groups (P > 0.05). However, the middle to distal curve change ratio was significantly lower in patients with aggravated shoulder balance (P < 0.05). In addition, patients with smaller preoperative shoulder imbalance showed the higher chance of aggravation after surgery with similar postoperative changes (P < 0.05).
Significant relations were found between correction rate of middle, and distal curvature, and postoperative shoulder balance. In addition, preoperative shoulder level difference can be a determinant of postoperative shoulder balance.
确定影响 AIS 术后肩部平衡的因素。
本研究纳入了 89 例接受手术治疗的青少年特发性脊柱侧凸（AIS）伴六种类型弯曲的患者。术前和术后均获得全脊柱前后位和侧位 X 线片。在 X 线片上，分析了弯曲的形状和变化。此外，还分析了四个肩部参数和冠状面平衡，以确定与术后肩部平衡显著相关的因素。
总体而言，所有四个肩部参数（CHD、CA、CRID、RSH）在最终随访时均略有增加（t 检验，P < 0.05），尽管 Lenke Ⅱ型和Ⅳ型弯曲减少。然而，术前和术后肩部参数在每个弯曲类型之间没有显著差异（ANOVA，P > 0.05）。此外，近端融合组不同水平的术前和术后肩部水平之间没有显著差异（ANOVA，P > 0.05）。在冠状面弯曲变化的分析中，改善肩部平衡和加重肩部平衡组之间的各个冠状面弯曲没有差异（P > 0.05）。然而，肩部平衡加重组的中远端曲线变化比例明显较低（P < 0.05）。此外，术前肩部失衡较小的患者在术后有更大的加重机会，且术后变化相似（P < 0.05）。
中、远端曲线的矫正率与术后肩部平衡之间存在显著关系。此外，术前肩部水平差异可以是术后肩部平衡的决定因素。
