骨盆参数能否确定Lenke 1型青少年特发性脊柱侧凸（AIS）患者术后的最佳胸椎后凸角度？
Could pelvic parameters determine optimal postoperative thoracic kyphosis in Lenke type 1 AIS patients?
作者信息
Liu Shunan, Zhang Yuancheng, Bao Hongda, Yan Peng, Zhu Zezhang, Liu Zhen, Qian Bangping, Qiu Yong
机构信息
Spine Surgery, Nanjing Drum Town Hospital, Nanjing University Medical School, Nanjing, 210008, China.
出版信息
BMC Musculoskelet Disord. 2018 Mar 7;19(1):74. doi: 10.1186/s12891-018-1992-z.
BACKGROUND
A proper restoration of sagittal alignment is essential in AIS patients, but few studies provided a formula to predict an optimal surgical thoracic kyphosis (TK) gain in adolescent idiopathic scoliosis (AIS) patients. A formula was recently proposed (LL = (PI+TK)/2 + 10) to predict the optimal lumbar lordosis (LL) in adult spinal deformity patients, which has not been validated in adolescents. The aim of this study is to establish a formula with TK and pelvic parameters in normal adolescents and predict an optimal TK with this formula pre- and post-operatively in Lenke 1 AIS patients.
METHODS
A total of 60 asymptomatic adolescents were used to validate the proposed formula. The subject was considered to match with the formula, if the difference between the virtual TK and the theoretical TK was less than 10°. Then regression analysis was performed to establish a new formula to predict TK in adolescents. The predictive efficiency of the new formula was also validated in 40 Lenke 1 AIS patients.
RESULTS
Of the 60 asymptomatic adolescents, only 26 (43.33%) asymptomatic adolescents matched with the adjusted formula: TK = 2 × (LL-10)-PI. The paired t test revealed a significantly different theoretical TK (tTK) compared to the virtual TK (41.23 ± 18.29° vs. 24.80 ± 8.75°, P < 0.001). Multiple linear regression showed that TK had a relationship with LL, SS and age (R = 0.331): TK = - 0.785 × LL-0.843 × SS + 0.858 × age + 3.754. There were 27 (67.50%), 32 (80.00%) and 35 (87.50%) Lenke 1 AIS patients matched this formula preoperatively, postoperatively and at the last follow-up.
CONCLUSION
Our results revealed that the predictive formula for sagittal alignment for adults was not applicable in adolescents. This study established a new predictive formula for TK based on asymptomatic adolescents. In Lenke 1 AIS patients, post-op TK in 87.5% of patients matched the predictive value, indicating that the new formula can be considered as a reference when making a surgery strategy.
背景
矢状面排列的恰当恢复对青少年特发性脊柱侧凸（AIS）患者至关重要，但很少有研究提供预测AIS患者最佳手术胸椎后凸（TK）增加量的公式。最近提出了一个公式（LL = (PI + TK)/2 + 10）来预测成人脊柱畸形患者的最佳腰椎前凸（LL），该公式尚未在青少年中得到验证。本研究的目的是在正常青少年中建立一个包含TK和骨盆参数的公式，并在Lenke 1型AIS患者术前和术后用该公式预测最佳TK。
方法
共60名无症状青少年用于验证所提出的公式。如果虚拟TK与理论TK之间的差异小于10°，则该受试者被认为与公式匹配。然后进行回归分析以建立一个预测青少年TK的新公式。新公式的预测效率也在40例Lenke 1型AIS患者中得到验证。
结果
在60名无症状青少年中，只有26名（43.33%）无症状青少年与调整后的公式匹配：TK = 2×(LL - 10) - PI。配对t检验显示理论TK（tTK）与虚拟TK有显著差异（41.23±18.29°对24.80±8.75°，P < 0.001）。多元线性回归显示TK与LL、SS和年龄有关（R = 0.331）：TK = -0.785×LL - 0.843×SS + 0.858×年龄 + 3.754。分别有27名（67.50%）、32名（80.00%）和35名（87.50%）Lenke 1型AIS患者在术前、术后及最后一次随访时符合该公式。
结论
我们的结果显示，成人矢状面排列的预测公式不适用于青少年。本研究基于无症状青少年建立了一个新的TK预测公式。在Lenke 1型AIS患者中，87.5%的患者术后TK与预测值匹配，表明新公式在制定手术策略时可作为参考。
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