治疗Lenke 2A型青少年特发性脊柱侧凸时下固定椎的选择
Selection of lower instrumented vertebra in treating Lenke type 2A adolescent idiopathic scoliosis.
作者信息
Cao Kai, Watanabe Kota, Kawakami Noriaki, Tsuji Taichi, Hosogane Naobumi, Yonezawa Ikuho, Machida Masafumi, Yagi Mitsuru, Kaneko Shinjiro, Toyama Yoshiaki, Matsumoto Morio
机构信息
*Department of Orthopedic Surgery, Keio University, Tokyo, Japan †Department of Orthopedic Surgery, the First Affiliated Hospital of Nanchang University, Nanchang, China ‡Department of Advanced Therapy for Spine and Spinal Cord Disorders, Keio University, Tokyo, Japan §Department of Orthopedic Surgery, Meijo Hospital, Nagoya, Japan ¶Department of Orthopedic Surgery, Juntendo Hospital, Tokyo, Japan; and ‖Department of Orthopedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan.
出版信息
Spine (Phila Pa 1976). 2014 Feb 15;39(4):E253-61. doi: 10.1097/BRS.0000000000000126.
STUDY DESIGN
A retrospective, observational, and multicenter study.
OBJECTIVE
To identify the ideal lower instrumented vertebra (LIV) to prevent distal adding-on after surgical correction of Lenke type 2A curve.
SUMMARY OF BACKGROUND DATA
LIV level may affect the risk of postsurgical adding-on. The choice of the last touching vertebra (LTV)-the most caudal vertebra of the main thoracic curve that touches the central sacral vertical line when standing-as an appropriate LIV has been validated for Lenke type 1A but not type 2A curve.
METHODS
Radiographs obtained before, immediately after, and 2 years after surgery were evaluated for 116 consecutive patients who underwent posterior thoracic fusion surgery for Lenke type 2A curve. The LIV was proximal to the LTV in 18 patients (PLTV), distal in 43 (DLTV), and at the LTV in 55 (ALTV). Significant independent factors associated with adding-on were analyzed first by univariate analysis, and then by stepwise logistic regression analysis.
RESULTS
Distal adding-on was present in 16 patients (13.8%) at follow-up: 9 PLTV (50.0%), 3 DLTV (7.0%), and 4 ALTV (7.3%). Adding-on was significantly more common in the PLTV group. One PLTV-group patient required revision surgery to treat adding-on. Univariate analysis identified the following significant factors associated with adding-on: the T2-T5 kyphosis angle and shoulder height before, immediately after, and 2 years after surgery; the lumbar Cobb angle at the 2-year follow-up; the 2-year postoperative lumbar curve correction rate; and the difference between the LIV and the end vertebra, neutral vertebra, and LTV levels. Significant independent risk factors identified by stepwise logistic regression analysis included the clavicle angle at follow-up, the correction rate of the lumbar curve immediately after surgery, and the difference between the LIV and LTV levels.
CONCLUSION
A LIV at or distal to the LTV may prevent postoperative adding-on in Lenke type 2A curve.
LEVEL OF EVIDENCE
研究设计
一项回顾性、观察性多中心研究。
目的
确定理想的下固定椎（LIV），以预防Lenke 2A型脊柱侧弯手术矫正后远端附加现象。
背景数据总结
LIV水平可能影响术后附加现象的风险。对于Lenke 1A型脊柱侧弯，选择最后接触椎（LTV）——站立时主胸弯最尾端且接触中央骶骨垂直线的椎体——作为合适的LIV已得到验证，但对于2A型脊柱侧弯尚未得到验证。
方法
对116例接受Lenke 2A型脊柱侧弯后路胸椎融合手术的连续患者，评估其术前、术后即刻及术后2年的X线片。18例患者的LIV位于LTV近端（PLTV组），43例位于远端（DLTV组），55例位于LTV水平（ALTV组）。首先通过单因素分析，然后通过逐步逻辑回归分析，分析与附加现象相关的显著独立因素。
结果
随访时16例患者（13.8%）出现远端附加现象：9例PLTV组患者（50.0%），3例DLTV组患者（7.0%），4例ALTV组患者（7.3%）。附加现象在PLTV组更为常见。1例PLTV组患者因附加现象需要翻修手术。单因素分析确定了以下与附加现象相关的显著因素：术前、术后即刻及术后2年的T2 - T5后凸角和肩高；术后2年随访时的腰椎Cobb角；术后2年腰椎侧弯矫正率；以及LIV与终椎、中立椎和LTV水平之间的差异。逐步逻辑回归分析确定的显著独立危险因素包括随访时的锁骨角、术后即刻腰椎侧弯的矫正率以及LIV与LTV水平之间的差异。
结论
LIV位于LTV或其远端可能预防Lenke 2A型脊柱侧弯术后的附加现象。
证据等级
3级。
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