Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Spine J. 2018 Jan;18(1):53-62. doi: 10.1016/j.spinee.2017.06.020. Epub 2017 Jul 24.
Selection of upper instrumented vertebra for Lenke 5 and 6 curves remains debatable, and several authors have described different selection strategies.
This study analyzed the flexibility of the unfused thoracic segments above the "potential upper instrumented vertebrae (UIV)" (T1-T12) and its compensatory ability in Lenke 5 and 6 curves using supine side bending (SSB) radiographs.
A retrospective study was used.
This study comprised 100 patients.
The ability of the unfused thoracic segments above the potential UIV, that is, T1-T12, to compensate in Lenke 5 and 6 curves was determined. We also analyzed postoperative radiological outcome of this cohort of patients with a minimum follow-up of 12 months.
Right and left SSB were obtained. Right side bending (RSB) and left side bending (LSB) angles were measured from T1 to T12. Compensatory ability of thoracic segments was defined as the ability to return to neutral (center sacral vertical line [CSVL]) with the assumption of maximal correction of lumbar curve with a horizontal UIV. The Lenke 5 curves were classified as follows: (1) Lenke 5-ve (mobile): main thoracic Cobb angle <15° and (2) Lenke 5+ve (stiff): main thoracic Cobb angle 15.0°-24.9°. This study was self-funded with no conflict of interest.
There were 43 Lenke 5-ve, 31 Lenke 5+ve, and 26 Lenke 6 curves analyzed. For Lenke 5-ve, >70% of thoracic segments were able to compensate when UIV were at T1-T8 and T12 and >50% at T9-T11. For Lenke 5+ve, >70% at T1-T6 and T12, 61.3% at T7, 38.7% at T8, 3.2% at T9, 6.5% at T10, and 22.6% at T11 were able to compensate. For Lenke 6 curve, >70% at T1-T6, 69.2% at T7, 19.2% at T8, 7.7% at T9, 0% at T10, 3.8% at T11, and 34.6% at T12 were able to compensate. There was a significant difference between Lenke 5-ve versus Lenke 5+ve and Lenke 5-ve versus Lenke 6 from T8 to T11. There were no significance differences between Lenke 5+ve and Lenke 6 curves from T1 to T11.
The compensatory ability of the unfused thoracic segment of Lenke 5+ve curves was different from the Lenke 5-ve curves, and it demonstrated characteristics similar to the Lenke 6 curves.
选择用于 Lenke 5 和 6 型曲线的上置器械椎仍然存在争议，已有几位作者描述了不同的选择策略。
本研究通过仰卧位侧屈（SSB）片分析了“潜在上置器械椎（UIV）”（T1-T12）以上未融合的胸段的柔韧性及其在 Lenke 5 和 6 型曲线上的代偿能力。
回顾性研究。
本研究包括 100 名患者。
确定了潜在 UIV 以上未融合的胸段（即 T1-T12）在 Lenke 5 和 6 型曲线上的代偿能力。我们还分析了这组患者的术后放射学结果，这些患者的随访时间至少为 12 个月。
获得右侧和左侧 SSB。从 T1 到 T12 测量右侧弯曲（RSB）和左侧弯曲（LSB）角度。胸段的代偿能力定义为在假设最大矫正腰椎曲线的情况下，回到中立位（中骶骨垂直线[CSVL]）的能力。Lenke 5 型曲线分为以下几类：（1）Lenke 5-ve（活动）：主胸 Cobb 角<15°和（2）Lenke 5+ve（僵硬）：主胸 Cobb 角 15.0°-24.9°。本研究为自筹资金，不存在利益冲突。
分析了 43 例 Lenke 5-ve、31 例 Lenke 5+ve 和 26 例 Lenke 6 型曲线。对于 Lenke 5-ve，当 UIV 在 T1-T8 和 T12 以及 T9-T11 时，>70%的胸段能够代偿；而当 UIV 在 T7 时，>50%的胸段能够代偿。对于 Lenke 5+ve，>70%在 T1-T6 和 T12，61.3%在 T7，38.7%在 T8，3.2%在 T9，6.5%在 T10，和 22.6%在 T11 时能够代偿。对于 Lenke 6 型曲线，>70%在 T1-T6，69.2%在 T7，19.2%在 T8，7.7%在 T9，0%在 T10，3.8%在 T11 和 34.6%在 T12 时能够代偿。从 T8 到 T11，Lenke 5-ve 与 Lenke 5+ve 和 Lenke 5-ve 与 Lenke 6 型曲线之间存在显著差异。从 T1 到 T11，Lenke 5+ve 与 Lenke 6 型曲线之间没有显著差异。
Lenke 5+ve 型曲线未融合胸段的代偿能力与 Lenke 5-ve 型曲线不同，表现出与 Lenke 6 型曲线相似的特征。
