肋骨隆起在Lenke 5型特发性青少年脊柱侧凸选择性融合上方胸段曲线矫正中的预后作用

Prognostic Role of Rib Hump in Overlying Thoracic Curve Correction Above Selective Fusion for Lenke 5 Idiopathic Adolescent Scoliosis.

作者信息

Solla Federico, Gallo Massimiliano, Doria Carlo, Caci Hervé, Voury Audrey, Rosello Olivier, Clément Jean-Luc, Rampal Virginie

机构信息

Pediatric Orthopaedic and Scoliosis Surgery, Lenval University Children's Hospital, Nice, France.

Orthopaedic Surgery, University Hospital of Sassari, Sassari, Italy.

出版信息

Clin Spine Surg. 2018 Mar;31(2):E140-E145. doi: 10.1097/BSD.0000000000000590.

DOI:10.1097/BSD.0000000000000590

PMID:29088010

Abstract

STUDY DESIGN

Prospective study.

OBJECTIVE

To assess whether rib hump is a prognostic factor of final thoracic Cobb angle.

SUMMARY OF BACKGROUND DATA

Correction of thoracolumbar/lumbar curve, preoperative thoracic curves angle, thoracic curves angle on bending, the thoracolumbar-lumbar angle/thoracic curves angle ratio, thoracic kyphosis, and growth stage influences spontaneous correction of uninstrumented thoracic curves angle above selective fusion for Lenke 5 Adolescent Idiopathic Scoliosis. Indeed, preoperative rib hump has never been expressly evaluated as a prognostic factor of final thoracic curves angle.

METHODS

In total, 50 patients with Lenke 5 Adolescent Idiopathic Scoliosis, selectively instrumented with posterior construct were included. Two patients were lost to follow-up and 48 had follow-up ≥2 years. Demographic data, preoperative thoracic rib hump (measured in millimeter in trunk anteflexion), and radiologic spinal parameters were recorded preoperatively and at last consultation. T test was used to compare mean values, linear and logistic regressions to assess predictability of final thoracic curve angle.

RESULTS

Main thoracolumbar-lumbar curve angle decreased from 47 degrees (range, 36-72 degrees) to 12 degrees at the final consultation (range, 1-28 degrees). Thoracic curves angle decreased from 26 degrees (range, 2-40 degrees) preoperatively to 16 degrees (range, 2-41 degrees) at the final consultation (P=0.001) (correction=37%). Preoperative rib hump was present in 10 patients. Final thoracic Cobb angle was 27 degrees (8-41 degrees) in patients with rib hump and 14 degrees (0-32 degrees) in patients without rib hump (P<0.001).Multiregression highlighted thoracic curves angle on bending (P=0.001), preoperative thoracic curves angle (P=0.011) and rib hump (P=0.012) as prognostic factors of higher final thoracic curves angle.

CONCLUSION

Rib hump significantly influenced final thoracic curves angle.

LEVEL OF EVIDENCE

Level III-prospective study.

摘要

研究设计

前瞻性研究。

目的

评估肋骨隆突是否为最终胸椎Cobb角的预后因素。

背景资料总结

胸腰段/腰椎曲线的矫正、术前胸椎曲线角度、弯曲时胸椎曲线角度、胸腰段-腰椎角度/胸椎曲线角度比值、胸椎后凸以及生长阶段会影响Lenke 5型青少年特发性脊柱侧凸选择性融合上方未行器械固定的胸椎曲线角度的自然矫正。事实上，术前肋骨隆突从未被明确评估为最终胸椎曲线角度的预后因素。

方法

总共纳入50例接受后路结构选择性器械固定的Lenke 5型青少年特发性脊柱侧凸患者。2例患者失访，48例患者随访时间≥2年。术前及末次随访时记录人口统计学数据、术前胸椎肋骨隆突（在躯干前屈时以毫米为单位测量）以及放射学脊柱参数。采用t检验比较均值，采用线性回归和逻辑回归评估最终胸椎曲线角度的可预测性。

结果

主要胸腰段-腰椎曲线角度从47度（范围36 - 72度）降至末次随访时的12度（范围1 - 28度）。胸椎曲线角度从术前的26度（范围2 - 40度）降至末次随访时的16度（范围2 - 41度）（P = 0.001）（矫正率 = 37%）。10例患者存在术前肋骨隆突。有肋骨隆突患者的最终胸椎Cobb角为27度（8 - 41度），无肋骨隆突患者为14度（0 - 32度）（P < 0.001）。多元回归分析显示，弯曲时胸椎曲线角度（P = 0.001）、术前胸椎曲线角度（P = 0.011）和肋骨隆突（P = 0.012）是最终胸椎曲线角度较高的预后因素。