Zhang ShengFei, Zhang Liang, Feng XinMin, Yang HuiLin
Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People's Republic of China.
Department of Orthopaedics, Northern Jiangsu People's Hospital, Yangzhou, 225001, People's Republic of China.
Eur Spine J. 2018 Feb;27(2):358-369. doi: 10.1007/s00586-017-5289-y. Epub 2017 Sep 9.
This is the first systematic review and meta-analysis to detect the incidence and risk factors for postoperative shoulder imbalance (PSI) in scoliosis.
A systematic online search was conducted to identify eligible studies. ES, OR and WMD with 95% CI were used to assess the incidence and risk factors associated with PSI.
Twenty-six studies were recruited. The pooled incidence of PSI was 25% (95% CI 20-31%). The incidence in Lenke 1 AIS, Lenke 2 AIS, Lenke 5 AIS and mixed AIS was 20% (9-31%), 26% (15-37%), 31% (17-45%) and 27% (19-35%), respectively. Using RSH ≥10 mm as the criterion of PSI, we found that preoperative LC, postoperative RSH, correction rate of MTC at follow-up were primary risk factors for PSI at follow-up. In the analysis of using RSH ≥20 mm as the criterion of PSI, our results showed that Risser sign, postoperative RSH, correction rate of PTC at follow-up, and LC at follow-up were contributing to PSI. Besides, scoliosis patients with PSI were more likely to suffer from adding-on.
The pooled incidence of PSI in scoliosis was 25%. Risser sign, preoperative LC, postoperative RSH, correction rate of PTC at follow-up, correction rate of MTC at follow-up, and LC at follow-up were risk factors for PSI in patients with scoliosis. Adding-on might be a compensatory mechanism for PSI. It is recommended that (1) sufficient correction of PTC and moderate correction of MTC and LC in the operation should be performed; (2) PSI should be prevented not only for the patients' postoperative appearance, but also for preventing the adding-on phenomenon.
这是第一项旨在检测脊柱侧弯术后肩部失衡（PSI）发生率及危险因素的系统评价和荟萃分析。
进行系统的在线检索以确定符合条件的研究。采用效应量（ES）、比值比（OR）和加权均数差（WMD）及95%置信区间（CI）来评估与PSI相关的发生率和危险因素。
纳入26项研究。PSI的合并发生率为25%（95%CI 20 - 31%）。Lenke 1型特发性脊柱侧弯（AIS）、Lenke 2型AIS、Lenke 5型AIS和混合型AIS的发生率分别为20%（9 - 31%）、26%（15 - 37%）、31%（17 - 45%）和27%（19 - 35%）。以术后双肩高度差（RSH）≥10 mm作为PSI的标准，我们发现术前腰椎侧凸（LC）、术后RSH、随访时胸弯（MTC）矫正率是随访时PSI的主要危险因素。在以RSH≥20 mm作为PSI标准的分析中，我们的结果显示Risser征、术后RSH、随访时胸腰弯（PTC）矫正率和随访时LC与PSI有关。此外，患有PSI的脊柱侧弯患者更易出现附加现象。
脊柱侧弯患者PSI的合并发生率为25%。Risser征、术前LC、术后RSH、随访时PTC矫正率、随访时MTC矫正率和随访时LC是脊柱侧弯患者PSI的危险因素。附加现象可能是PSI的一种代偿机制。建议：（1）手术中应充分矫正PTC，适度矫正MTC和LC；（2）预防PSI不仅是为了患者术后外观，也是为了防止附加现象的发生。
