Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Spine (Phila Pa 1976). 2018 Jun 1;43(11):780-790. doi: 10.1097/BRS.0000000000002423.
A systematic review and meta-analysis.
To discuss the prevalence, risk factors, and characteristics of the "adding-on" phenomenon in idiopathic scoliosis (IS).
There are controversies on the prevalence and risk factors of the "adding-on" phenomenon. In addition, there is no comprehensive study to describe the characteristics of "adding-on" in IS patients.
We performed a systematic online search using PubMed, EMBASE, Web of Science, the Cochrane Library, and China WeiPu Library to identify eligible studies. Effect size (ES), odds ratios (OR), and weight mean difference (WMD) with 95% confidence interval (CI) were used to evaluate the incidence, characteristics, and risk factors for "adding-on," respectively.
The overall pooled prevalence of "adding-on" was 14%. Subgroup analysis showed that the prevalence of "adding-on" in Lenke 1A adolescent idiopathic scoliosis (AIS), Lenke 2 AIS, Lenke 5 AIS, and mixed AIS was 15%, 12%, 9%, and 16%, respectively. AIS patients with the "adding-on" phenomenon had smaller proximal thoracic curve (PTC), main thoracic curve (MTC), clavicle angle, T1 tilt angle and radiographic shoulder height (RSH), and larger correction of PTC. Age, Risser sign, preoperative PTC, preoperative MTC, preoperative lumbar curve (LC), preoperative coronal balance and sagittal balance, and T4 tile were identified as risk factors of "adding-on." Selection of lower instrumented vertebra (LIV) was also an important risk factor as LIV-Center Sacral Vertical Line (CSVL), LIV-end vertebra, LIV-Stable Vertebra, and LIV-Neutral vertebra, and deviation of LIV+1 was found to be significantly associated with "adding-on." Besides, postoperative MTC was also significantly different between patients with and without "adding-on."
The pooled prevalence varied differently in different types of IS. Patients with "adding-on" had smaller PTC, MTC, angle, T1 tilt angle and RSH, and larger correction of PTC. Younger age, less skeletal maturity, smaller preoperative PTC, smaller preoperative MTC, smaller preoperative LC, larger preoperative coronal, sagittal imbalance, selection of LIV, and overcorrection of coronal and sagittal alignment were risk factors for "adding-on."
系统评价和荟萃分析。
探讨特发性脊柱侧凸（IS）中“附加”现象的发生率、危险因素和特征。
“附加”现象的发生率和危险因素存在争议。此外，尚无综合研究来描述 IS 患者“附加”的特征。
我们使用 PubMed、EMBASE、Web of Science、Cochrane 图书馆和中国维普数据库进行了系统的在线搜索，以确定合格的研究。使用效应大小（ES）、优势比（OR）和加权均数差（WMD）及其 95%置信区间（CI）分别评估“附加”的发生率、特征和危险因素。
“附加”的总体汇总患病率为 14%。亚组分析显示，Lenke 1A 青少年特发性脊柱侧凸（AIS）、Lenke 2 AIS、Lenke 5 AIS 和混合 AIS 中“附加”的患病率分别为 15%、12%、9%和 16%。具有“附加”现象的 AIS 患者的近端胸弯（PTC）、主胸弯（MTC）、锁骨角、T1 倾斜角和放射学肩高（RSH）较小，而 PTC 的矫正较大。年龄、Risser 征、术前 PTC、术前 MTC、术前腰椎曲线（LC）、术前冠状和矢状平衡以及 T4 倾斜被确定为“附加”的危险因素。选择较低的器械固定椎（LIV）也是一个重要的危险因素，因为 LIV-中心骶骨垂直线（CSVL）、LIV-末端椎、LIV-稳定椎和 LIV-中性椎，以及 LIV+1 的偏差与“附加”明显相关。此外，术后 MTC 在有和无“附加”的患者之间也有显著差异。
不同类型的 IS 中“附加”的患病率存在差异。具有“附加”现象的患者 PTC、MTC、角度、T1 倾斜角和 RSH 较小，而 PTC 的矫正较大。年龄较小、骨骼成熟度较低、术前 PTC 较小、术前 MTC 较小、术前 LC 较小、术前冠状和矢状失平衡较大、LIV 选择、冠状和矢状矫正过度是“附加”的危险因素。
4 级。
