Zhao Jian, Chen Ziqiang, Yang Mingyuan, Li Gengwu, Zhao Yingchuan, Li Ming
Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai Panzhihua Central Hospital, Panzhihua, Sichuan Province, China.
Medicine (Baltimore). 2018 Feb;97(5):e9764. doi: 10.1097/MD.0000000000009764.
The aim of this stusy was to investigate whether spinal fusion to T2, T3, or T4 affects sagittal alignment of the cervical spine in Lenke 1 adolescent idiopathic scoliosis (AIS) patients.A retrospective study comprised of 64 Lenke 1 AIS patients was performed to assess the radiographic and clinical outcome. According to the upper instrumented vertebrae (UIV) (T2, T3, or T4), the patients were divided into 3 groups. Comparison analyses were performed among these 3 groups of patients as between pre-op, immediate post-op, and final follow-up, as well as between these groups.Between groups, comparison analyses did not detect a statistical difference in cervical lordosis (CL) preoperatively (P = .501), immediately after surgery (P = .795), and at follow-up (P = .510). Immediately after surgery, CL increased significantly in all groups (T2, P = .004, T3, P < .001 and T4, P = .002 respectively). Compared with immediate postoperatively, CL at final follow-up increased in T2 group (P = .037), and T4 group (P = .010). Furthermore, CL at follow-up was significantly correlated with the following parameters: preoperative (coronal plane balance [r = .349, P = .004], pelvic tilt [r = 0.347, P = .004), pelvic incidence [r = 0.261, P = .031], and CL [r = 0.471, P < .001]) immediately postoperative (CL [r = 0.946, P < .001], T1-slope [r = -0.646, P < .001], and thoracic kyphosis [TK] [r = -0.353, P = .003]), and at follow-up (TK [r = -0.342, P = .004], and T1-slope [r = -0.821, P < .001]). However, there was no significant correlation between a selection of UIV and CL at follow-up (r = 0.031, P = .802). Moreover, Scoliosis Research Society (SRS-22) scores between groups were similar preoperatively (P = .242), immediately after surgery (P = .828), and at follow-up (P = .219).In Lenke 1 AIS patients, the selection of UIV mainly affects the coronal plane, especially shoulder balance. Fusion to T2, T3, or T4 did not affect the alignment of the cervical spine, and the SRS-22 score.
Level IV.
本研究的目的是调查在Lenke 1型青少年特发性脊柱侧凸（AIS）患者中，融合至T2、T3或T4是否会影响颈椎矢状面排列。对64例Lenke 1型AIS患者进行了一项回顾性研究，以评估影像学和临床结果。根据上固定椎（UIV）（T2、T3或T4），将患者分为3组。对这3组患者在术前、术后即刻和最终随访之间以及这些组之间进行了比较分析。组间比较分析未发现术前颈椎前凸（CL）有统计学差异（P = 0.501），术后即刻（P = 0.795）和随访时（P = 0.510）也无差异。术后即刻，所有组的CL均显著增加（T2组，P = 0.004；T3组，P < 0.001；T4组，P = 0.002）。与术后即刻相比，T2组（P = 0.037）和T4组（P = 0.010）在最终随访时CL增加。此外，随访时的CL与以下参数显著相关：术前（冠状面平衡[r = 0.349，P = 0.004]、骨盆倾斜[r = 0.347，P = 0.004]、骨盆入射角[r = 0.261，P = 0.031]和CL[r = 0.471，P < 0.001]）、术后即刻（CL[r = 0.946，P < 0.001]、T1斜率[r = -0.646，P < 0.001]和胸椎后凸[TK][r = -0.353，P = 0.003]）以及随访时（TK[r = -0.342，P = 0.004]和T1斜率[r = -0.821，P < 0.001]）。然而，随访时选择的UIV与CL之间无显著相关性（r = 0.031，P = 0.802）。此外，术前（P = 0.242）、术后即刻（P = 0.828）和随访时（P = 0.219）各组间脊柱侧凸研究学会（SRS - 22）评分相似。在Lenke 1型AIS患者中，UIV的选择主要影响冠状面，尤其是肩部平衡。融合至T2、T3或T4不影响颈椎排列和SRS - 22评分。
IV级。
