Matsumoto Morio, Watanabe Kota, Kawakami Noriaki, Tsuji Taichi, Uno Koki, Suzuki Teppei, Ito Manabu, Yanagida Haruhisa, Minami Shohei, Akazawa Tsutomu
Department of Orthopaedic Surgery, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo #160-8582, Japan.
BMC Musculoskelet Disord. 2014 Nov 5;15:366. doi: 10.1186/1471-2474-15-366.
The purpose of this study was to investigate the occurrence and factors associated with postoperative shoulder imbalance (PSI) in Lenke type 1A curve.
This study included 106 patients with Lenke Type 1A curve who were followed up more than two years after posterior correction surgery. Pedicle screw (PS) constructs were used in 84 patients, and hybrid constructs in 22. The upper instrumented vertebra was rostral to the upper-end vertebra (UEV) in 70 patients, at UEV in 26, and below UEV in 10. The clavicle angle and T1 tilt angle were measured as PSI indicators, and correlations between radiographic parameters of shoulder balance and other radiographic parameters and associations between PSI and clinical parameters were investigated. For statistical analyses, paired and unpaired t-tests were used.
The mean Cobb angles of the main and proximal thoracic curves were 54.6 ± 9.5 and 26.7 ± 7.9 degrees before surgery, 14.5 ± 7.5, and 14.9 ± 7.1 at follow-up. Clavicle angle and T1 tilt angle were -2.9 ± 2.8 and -2.6 ± 6.3 before surgery, 2.4 ± 2.8 and 4.4 ± 4.3 immediately after surgery, and 1.8 ± 2.1 and 3.4 ± 5.5 at follow-up. Twenty patients developed distal adding-on. Clavicle angle at follow-up correlated weakly but significantly with preoperative clavicle angle (r = 0.34, p = 0.001) and with the correction rates of the main thoracic curve (r = 0.34, p = 0.001); it correlated negatively with the proximal curve spontaneous correction rate (r=-0.21, p = 0.034). The clavicle angle at follow-up was significantly larger in patients with PS-only constructs (PS 2.1 degrees vs. hybrid 0.9, p = 0.02), and tended to be smaller in patients with distal adding-on (adding-on 1.1 vs. non adding-on 2.0, p = 0.09).
PSI was more common with better correction of the main curve (using PS constructs), in patients with a larger preoperative clavicle angle, and with a larger and more rigid proximal curve. Distal adding-on may compensate for PSI.
本研究旨在调查Lenke 1A型脊柱侧凸术后肩部失衡（PSI）的发生率及相关因素。
本研究纳入了106例接受后路矫正手术且随访超过两年的Lenke 1A型脊柱侧凸患者。84例患者使用椎弓根螺钉（PS）内固定，22例使用混合内固定。70例患者的上固定椎位于上端椎（UEV）上方，26例位于UEV水平，10例位于UEV下方。测量锁骨角和T1倾斜角作为PSI指标，研究肩部平衡的影像学参数与其他影像学参数之间的相关性，以及PSI与临床参数之间的关联。统计分析采用配对和非配对t检验。
术前主胸弯和近端胸弯的平均Cobb角分别为54.6±9.5度和26.7±7.9度，随访时分别为14.5±7.5度和14.9±7.1度。术前锁骨角和T1倾斜角分别为-2.9±2.8度和-2.6±6.3度，术后即刻分别为2.4±2.8度和4.4±4.3度，随访时分别为1.8±2.1度和3.4±5.5度。20例患者出现远端附加现象。随访时的锁骨角与术前锁骨角呈弱但显著的相关性（r = 0.34，p = 0.001），与主胸弯的矫正率呈显著相关性（r = 0.34，p = 0.001）；与近端弯自发矫正率呈负相关（r = -0.21，p = 0.034）。仅使用PS内固定的患者随访时的锁骨角显著更大（PS组为2.1度，混合组为0.9度，p = 0.02），出现远端附加现象的患者锁骨角往往更小（附加组为1.1度，非附加组为2.0度，p = 0.09）。
在主弯矫正较好（使用PS内固定）、术前锁骨角较大以及近端弯较大且较僵硬的患者中，PSI更为常见。远端附加现象可能会补偿PSI。
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