Terheyden Jan Henrik, Wetterkamp Mark, Gosheger Georg, Bullmann Viola, Liljenqvist Ulf, Lange Tobias, Schulze Bövingloh Albert, Schulte Tobias L
Department of Orthopaedics and Tumor Orthopaedics, Muenster University Hospital, Albert-Schweitzer Campus 1, 48149, Muenster, Germany.
Department of Spine Surgery, St. Franziskus-Hospital, Schönsteinstrasse 63, 50825, Cologne, Germany.
Eur Spine J. 2018 Feb;27(2):370-380. doi: 10.1007/s00586-017-5210-8. Epub 2017 Jul 8.
For patients with adolescent idiopathic scoliosis, shoulder balance influences their treatment satisfaction and psychological well-being. Several parameters are known to affect postoperative shoulder balance, but few prognostic models are as yet available.
This study aimed to identify independent predictive factors that can be used to assess preoperatively which patients are at risk of postoperative shoulder elevation, and to build a linear prediction model.
N = 102 patients with all Lenke types were reviewed radiographically before surgery and 1 year afterward. The outcome measures were coracoid height difference (CHD), clavicular angle (CA), and clavicle-first rib intersection difference (CiRID). Predictive factors commonly used in the literature were investigated using correlation analysis and statistical testing. Significant contributing factors were included in three multiple linear regression models (for CHD, CA, and CiRID).
The mean shoulder level (CHD) significantly changed from a lower left shoulder value of -8.5 mm before surgery to 3.3 mm at the follow-up examination. A high preoperative left shoulder level by CiRID, a large amount of Cobb angle correction of the distal thoracic curve, a low preoperative Cobb angle in the lumbar curve, and a structural proximal thoracic curve proved to be determinants and thus risk factors for left-sided shoulder elevation after surgery. The three models predicting CHD, CA, and CiRID at the follow-up examination included these four risk factors and were significant.
Preoperative variables have the strongest influence on shoulder level after spinal instrumentation. Additionally, extensive correction of the distal thoracic curve can cause elevation of the left shoulder.
对于青少年特发性脊柱侧凸患者，肩部平衡会影响他们的治疗满意度和心理健康。已知有几个参数会影响术后肩部平衡，但目前可用的预后模型很少。
本研究旨在确定可用于术前评估哪些患者有术后肩部抬高风险的独立预测因素，并建立一个线性预测模型。
对102例所有Lenke类型的患者在手术前和术后1年进行影像学检查。结果测量指标为喙突高度差（CHD）、锁骨角（CA）和锁骨-第一肋交点差（CiRID）。使用相关分析和统计检验对文献中常用的预测因素进行研究。将显著的影响因素纳入三个多元线性回归模型（分别针对CHD、CA和CiRID）。
平均肩部水平（CHD）从术前较低的左肩值-8.5mm显著变化为随访检查时的3.3mm。术前CiRID显示的高左肩水平、胸段远端曲线的大量Cobb角矫正、术前腰段曲线的低Cobb角以及结构性胸段近端曲线被证明是决定因素，因此也是术后左侧肩部抬高的危险因素。预测随访检查时CHD、CA和CiRID的三个模型包含这四个危险因素且具有显著性。
术前变量对脊柱内固定术后的肩部水平影响最大。此外，胸段远端曲线的广泛矫正可导致左肩抬高。
