选择Lenke 1A型脊柱侧弯中最后一个“实质性”接触椎体作为最低融合椎体：至少2年随访的影像学结果
Selecting the Last "Substantially" Touching Vertebra as Lowest Instrumented Vertebra in Lenke Type 1A Curve: Radiographic Outcomes With a Minimum of 2-year Follow-Up.
作者信息
Qin Xiaodong, Sun Weixiang, Xu Leilei, Liu Zhen, Qiu Yong, Zhu Zezhang
机构信息
Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
出版信息
Spine (Phila Pa 1976). 2016 Jun;41(12):E742-E750. doi: 10.1097/BRS.0000000000001374.
STUDY DESIGN
Retrospective study.
OBJECTIVE
To compare the long-term outcomes of correction surgery for Lenke 1A scoliosis patients among those with non-Substantially Touched Vertebra (nSTV), nSTV+1, or STV selected as lowest instrumented vertebra (LIV).
SUMMARY OF BACKGROUND DATA
Previous studies have documented good outcomes when last touching vertebra (LTV) was selected as LIV; however, it is sometimes confusing to determine the proper LTV when central sacral vertical line (CSVL) slightly touches the vertebra.
METHODS
A total of 104 patients were included in the study with a minimum of 2-year follow-up after selective posterior thoracic instrumentation. STV was defined as the LTV where CSVL was between the pedicles or touching the pedicle. nSTV was defined as the LTV where CSVL was touching the corner of the vertebra lateral to the pedicle border. Patients with nSTV, nSTV+1, or STV selected as LIV were assigned to three groups with clinical outcomes compared among them. Factors associated with the incidence of adding-on were analyzed.
RESULTS
Distal adding-on was observed in 23 patients (22.1%). The incidence of distal adding-on was significantly higher in nSTV group than STV group or nSTV+1 group. Several risk factors significantly associated with adding-on were identified, including the distance between LIV and STV/nSTV+1, preoperative proximal thoracic curve and sagittal vertical axis, postoperative lumbar lordosis, apical translation, trunk shift, and radiographical shoulder height. Logistic regression analysis showed that the distance between LIV and STV/nSTV+1 (LIV-STV <0 or LIV-(nSTV+1) <0) was the only independent factor associated with the incidence of adding-on (odds ratio = 27.1, 95% confidence interval = 2.3-311.2, P = 0.002).
CONCLUSION
Differentiating STV from nSTV properly can facilitate the determination of optimal LIV and decrease the incidence of distal adding-on. Selecting STV or nSTV+1 as LIV could yield a promising outcome for Lenke 1A scoliosis patients undergoing selective posterior thoracic fusion.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
比较在选择非实质触碰椎体（nSTV）、nSTV + 1或实质触碰椎体（STV）作为最低融合椎体（LIV）的情况下，Lenke 1A 型脊柱侧凸患者矫正手术的长期疗效。
背景数据总结
既往研究表明，选择最后触碰椎体（LTV）作为LIV时疗效良好；然而，当骶骨中心垂线（CSVL）轻微触碰椎体时，有时难以确定合适的LTV。
方法
本研究共纳入104例患者，在选择性后路胸椎内固定术后至少随访2年。STV定义为CSVL位于椎弓根之间或触碰椎弓根的LTV。nSTV定义为CSVL触碰椎弓根边界外侧椎体角的LTV。选择nSTV、nSTV + 1或STV作为LIV的患者被分为三组，比较它们之间的临床疗效。分析与附加手术发生率相关的因素。
结果
23例患者（22.1%）出现远端附加手术。nSTV组远端附加手术的发生率显著高于STV组或nSTV + 1组。确定了几个与附加手术显著相关的危险因素，包括LIV与STV/nSTV + 1之间的距离、术前近端胸椎曲度和矢状垂直轴、术后腰椎前凸、顶椎平移、躯干偏移和影像学肩部高度。逻辑回归分析表明，LIV与STV/nSTV + 1之间的距离（LIV - STV < 0或LIV - (nSTV + 1) < 0）是与附加手术发生率相关的唯一独立因素（比值比 = 27.1，95%置信区间 = 2.3 - 311.2，P = 0.002）。
结论
正确区分STV和nSTV有助于确定最佳LIV并降低远端附加手术的发生率。对于接受选择性后路胸椎融合术的Lenke 1A 型脊柱侧凸患者，选择STV或nSTV + 1作为LIV可能会取得良好的疗效。
证据水平
3级。
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