Jiang Jun, Qian Bang-Ping, Qiu Yong, Wang Bin, Yu Yang, Zhu Ze-Zhang
The Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
BMC Musculoskelet Disord. 2017 Aug 23;18(1):362. doi: 10.1186/s12891-017-1730-y.
To date, no study had reported the phenomenon of deteriorated postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients. The purpose of this study is to evaluate the cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder treated by either full fusion or partial/non fusion of the proximal thoracic curve.
A total of 30 Lenke type 2 AIS patients with preoperative right-elevated shoulder underwent posterior spinal instrumentation from 2009 to 2011 were included in this study. All the subjects were divided into 2 groups according to the selection of upper instrumented vertebra. There were 14 cases proximally fused to T1 or T2 (Group A) and 16 cases proximally fused to T3 or below (Group B). Both standing anteroposterior and sagittal X-ray films of the spine obtained preoperatively, one week after the operation, and at a minimum of two-year follow-up were analyzed with respect to the following parameters: cervical tilt, T1 tilt, proximal thoracic Cobb angle, main thoracic Cobb angle, apical vertebral translation of proximal thoracic curve, apical vertebral translation of main thoracic curve, radiographic shoulder height, cervical lordosis, proximal thoracic kyphosis and main thoracic kyphosis.
Most (83.3%) of the patients in these two groups gained satisfactory shoulder balance after surgery. However, the cervical tilt significantly improved in group A (p < 0.001) but deteriorated in group B (p < 0.001). In group A, the decrease of cervical tilt significantly positively correlated with that of T1 tilt (p < 0.001). In group B, the increase of cervical tilt significantly positively correlated with both the increase of T1 tilt (p < 0.001) and the increase of apical vertebral translation of proximal thoracic curve (p < 0.05).
Lenke type 2 AIS patients with right-elevated shoulder gain improved shoulder but deteriorated cervical tilt after partial/non fusion of proximal thoracic curve. Full fusion of proximal thoracic curve helps to prevent the residual cervical tilt in these patients.
迄今为止，尚无研究报道Lenke 2型青少年特发性脊柱侧凸患者术后颈椎倾斜度恶化的现象。本研究的目的是评估采用近端胸椎曲线全融合或部分/非融合治疗的Lenke 2型右肩抬高青少年特发性脊柱侧凸患者的颈椎倾斜度。
本研究纳入了2009年至2011年期间共30例术前右肩抬高的Lenke 2型AIS患者，这些患者均接受了后路脊柱内固定术。所有受试者根据上固定椎的选择分为2组。近端融合至T1或T2的有14例（A组），近端融合至T3或更低水平的有16例（B组）。对术前、术后1周以及至少两年随访时获得的脊柱站立位前后位和矢状位X线片进行分析，涉及以下参数：颈椎倾斜度、T1倾斜度、近端胸椎Cobb角、主胸椎Cobb角、近端胸椎曲线顶椎平移、主胸椎曲线顶椎平移、影像学肩高、颈椎前凸、近端胸椎后凸和主胸椎后凸。
这两组中的大多数患者（83.3%）术后获得了满意的肩部平衡。然而，A组颈椎倾斜度显著改善（p < 0.001），而B组颈椎倾斜度恶化（p < 0.001）。在A组中，颈椎倾斜度的降低与T1倾斜度的降低显著正相关（p < 0.001）。在B组中，颈椎倾斜度的增加与T1倾斜度的增加（p < 0.001）以及近端胸椎曲线顶椎平移的增加（p < 0.05）均显著正相关。
近端胸椎曲线部分/非融合后，Lenke 2型右肩抬高AIS患者的肩部得到改善，但颈椎倾斜度恶化。近端胸椎曲线全融合有助于预防这些患者残留颈椎倾斜度。
