锁骨与胸廓角度差异：它是Lenke I型青少年特发性脊柱侧凸术后肩部失衡的影像学及临床预测指标吗？
Clavicle Chest Cage Angle Difference: Is It a Radiographic and Clinical Predictor of Postoperative Shoulder Imbalance in Lenke I Adolescent Idiopathic Scoliosis?
作者信息
Han Xiao, Liu Zhen, Qiu Yong, Sha Shifu, Yan Huang, Jin Mengran, Zhu Zezhang
机构信息
Spine Surgery, Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
出版信息
Spine (Phila Pa 1976). 2016 Sep;41(17):1346-1354. doi: 10.1097/BRS.0000000000001521.
STUDY DESIGN
A retrospective study.
OBJECTIVE
To evaluate the effect of preoperative clavicle chest cage angle difference (CCAD) on postoperative radiographic shoulder imbalance, cosmetic shoulder balance, patient's satisfaction, and surgeon's fulfillment in Lenke I adolescent idiopathic scoliosis (AIS).
SUMMARY OF BACKGROUND DATA
CCAD is a novel predictor of postoperative radiographic shoulder imbalance in AIS. However, radiographic shoulder balance does not always correspond to cosmetic shoulder balance.
METHODS
Forty-four Lenke I AIS patients treated with posterior spinal fusion with a minimum 2-year follow-up were analyzed. Shoulder height difference (SHD) and CCAD were measured on anteroposterior standing radiographs. The inner shoulder height (SHi) and the outer shoulder height (SHo) were measured using the patients' photographs. The patients' satisfaction and the surgeons' fulfillment were evaluated using a questionnaire. A receiver operative characteristic curve analysis was performed to explore the threshold values of preoperative CCAD in the prediction of the final follow-up radiographic shoulder imbalance, patients' satisfaction, and surgeons' fulfillment.
RESULTS
At the final follow-up, the preoperative CCAD was significantly greater in patients with unbalanced shoulders (SHD ≥1 cm). For cosmetic shoulder balance at the final follow-up, there was no significant difference in preoperative CCAD between Group 1i (SHi ≥1 cm, n = 14) and Group 2i (SHi <1 cm, n = 30), and the preoperative CCAD was also similar between Group 1o (SHo ≥1 cm, n = 17) and Group 2o (SHo <1 cm, n = 27). For patients' satisfaction and surgeons' fulfillment, the preoperative CCAD was significantly greater in patients with unsatisfied outcomes. The threshold value of preoperative CCAD to predict the final follow-up radiographic shoulder imbalance, patients' satisfaction, and surgeons' fulfillment was 5.5°.
CONCLUSION
CCAD is a good radiographic predictor for postoperative radiographic shoulder imbalance in Lenke I AIS patients. Moreover, it is also associated with the patients' satisfaction and surgeons' fulfillment postoperatively. However, CCAD cannot predict postoperative cosmetic shoulder balance.
LEVEL OF EVIDENCE
研究设计
一项回顾性研究。
目的
评估术前锁骨胸廓角差（CCAD）对Lenke I型青少年特发性脊柱侧凸（AIS）患者术后影像学肩部失衡、肩部外观平衡、患者满意度及外科医生满意度的影响。
背景资料总结
CCAD是AIS患者术后影像学肩部失衡的一种新的预测指标。然而，影像学肩部平衡并不总是与肩部外观平衡相对应。
方法
分析44例接受后路脊柱融合术且随访至少2年的Lenke I型AIS患者。在站立位前后位X线片上测量肩高差异（SHD）和CCAD。使用患者照片测量内肩高（SHi）和外肩高（SHo）。通过问卷调查评估患者满意度和外科医生满意度。进行受试者工作特征曲线分析，以探索术前CCAD在预测末次随访时影像学肩部失衡、患者满意度及外科医生满意度方面的阈值。
结果
在末次随访时，肩部失衡（SHD≥1 cm）患者的术前CCAD显著更大。对于末次随访时的肩部外观平衡，1i组（SHi≥1 cm，n = 14）和2i组（SHi < 1 cm，n = 30）术前CCAD无显著差异，1o组（SHo≥1 cm，n = 17）和2o组（SHo < 1 cm，n = 27）术前CCAD也相似。对于患者满意度和外科医生满意度，结果不满意的患者术前CCAD显著更大。预测末次随访时影像学肩部失衡、患者满意度及外科医生满意度的术前CCAD阈值为5.5°。
结论
CCAD是Lenke I型AIS患者术后影像学肩部失衡的良好影像学预测指标。此外，它还与患者术后满意度及外科医生满意度相关。然而，CCAD不能预测术后肩部外观平衡。
证据级别
4级。
Zotero 插件