影响Lenke 1型和2型青少年特发性脊柱侧弯后路脊柱融合术后残余肋骨隆凸的因素。

Factors influencing the residual rib hump after posterior spinal fusion for adolescent idiopathic scoliosis with Lenke 1 and 2 curves.

作者信息

Mukaiyama Keijiro, Takahashi Jun, Hirabayashi Hiroki, Ogihara Nobuhide, Kuraishi Shugo, Shimizu Masayuki, Kato Hiroyuki

机构信息

Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan,

出版信息

J Orthop Sci. 2013 Sep;18(5):687-92. doi: 10.1007/s00776-013-0424-z. Epub 2013 Jun 8.

DOI:10.1007/s00776-013-0424-z

PMID:23749219

Abstract

BACKGROUND

Despite remarkable improvement in Cobb angle after surgery for scoliosis, many patients have a residual rib hump. We studied the factors responsible for this hump and their influence on patient satisfaction.

METHODS

We recruited 2 men and 38 women (mean age 14.9 years) who underwent skip pedicle screw fixation combined with direct vertebral body derotation for adolescent idiopathic scoliosis with Lenke type 1 and 2 curves. Hump size was evaluated by measuring apical trunk rotation (ATR). Patients with postoperative ATR ≤10° were categorized as group A and those with postoperative ATR >10° as group B. We analyzed postoperative self-image and satisfaction subscores of the SRS-22 questionnaire. We also compared the rate of postoperative improvement in ATR between patients who underwent additional Ponte osteotomy and those who did not.

RESULTS

Preoperative ATR, preoperative apical translation, and preoperative and postoperative apical rotation significantly differed between groups A and B. In contrast, Cobb angles before and after surgery, Cobb angle correction rates, apical translation after correction, and postoperative self-image and satisfaction scores did not differ significantly between the groups. However, the rate of improvement in ATR showed a strong correlation with self-image (correlation coefficient 0.64) and satisfaction (correlation coefficient 0.52). This improvement rate did not differ significantly between subjects who underwent additional Ponte osteotomy and those who did not.

CONCLUSIONS

Preoperative apical rotation and ATR were clearly related to postoperative residual hump. For decreasing the postoperative rib hump, removal of the deformation by apical rotation was considered more important than correction of Cobb angle. Patient satisfaction and self-image scores were not significantly related to postoperative residual hump size, but they were influenced by improvement in ATR.

摘要

背景

尽管脊柱侧弯手术后Cobb角有显著改善，但许多患者仍有残留的肋骨隆突。我们研究了导致这种隆突的因素及其对患者满意度的影响。

方法

我们招募了2名男性和38名女性（平均年龄14.9岁），他们因Lenke 1型和2型青少年特发性脊柱侧弯接受了跳跃式椎弓根螺钉固定联合椎体直接去旋转术。通过测量顶椎躯干旋转（ATR）来评估隆突大小。术后ATR≤10°的患者分为A组，术后ATR>10°的患者分为B组。我们分析了SRS-22问卷的术后自我形象和满意度子评分。我们还比较了接受额外Ponte截骨术和未接受该手术的患者术后ATR的改善率。

结果

A组和B组之间术前ATR、术前顶椎平移以及术前和术后顶椎旋转有显著差异。相比之下，两组手术前后的Cobb角、Cobb角矫正率、矫正后的顶椎平移以及术后自我形象和满意度评分没有显著差异。然而，ATR的改善率与自我形象（相关系数0.64）和满意度（相关系数0.52）显示出强烈的相关性。接受额外Ponte截骨术和未接受该手术的患者之间，这种改善率没有显著差异。