三柱截骨治疗胸腰椎先天性脊柱侧后凸冠状面失衡：发生率及危险因素。
Coronal Imbalance After Three-Column Osteotomy in Thoracolumbar Congenital Kyphoscoliosis: Incidence and Risk Factors.
机构信息
Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu Province.
Department of Spine Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
出版信息
Spine (Phila Pa 1976). 2019 Jan 15;44(2):E99-E106. doi: 10.1097/BRS.0000000000002773.
STUDY DESIGN
Retrospective radiographical clinical study.
OBJECTIVE
To investigate the incidence and risk factors of coronal imbalance (CI) after three-column osteotomy (3-CO) in patients with thoracolumbar congenital kyphoscoliosis (CKS).
SUMMARY OF BACKGROUND DATA
The incidence and risk factors of postoperative CI have been reported in adolescent idiopathic and degenerative lumbar scoliosis. However, limited data exists for patients with CKS after 3-CO.
METHODS
We reviewed a consecutive series of patients with CKS who underwent posterior-only 3-CO. Coronal curve patterns were classified according to absolute C7 translation values into: Type A, C7 translation is less than 30 mm; Type B, C7 translation more than or equal to 30 mm and C7 plumb line (C7PL) shifted to the concave side of the main curve; and Type C, C7 translation more than or equal to 30 mm and C7PL shifted to the convex side. CI was defined as C7 translation on either side more than or equal to 30 mm. According to C7 translation at the latest follow-up, patients was subdivided into an imbalanced group and a balanced group.
RESULTS
One-hundred-thirty patients (mean age, 17.7 ± 5.2 yr) were recruited. The mean follow-up was 41.3 ± 18.5 months. Twenty-six patients (20%) were identified as having CI at the latest follow-up. Compared with the balanced group, the imbalanced group had a larger proportion of preoperative Type C pattern, higher main curve correction, and greater lowest instrumented vertebra (LIV) tilt before and after surgery. Multiple logistic regression showed that risk factors for CI were preoperative type C pattern, preoperative LIV tilt more than or equal to 23.5° and immediate postoperative LIV tilt more than or equal to 12.3°.
CONCLUSION
The incidence of CI in patients with CKS after 3-CO was 20%. A preoperative type C pattern, preoperative LIV tilt more than or equal to 23.5°, and immediate postoperative LIV tilt more than or equal to 12.3° were found to be associated with CI at the latest follow-up.
LEVEL OF EVIDENCE
研究设计
回顾性影像学临床研究。
目的
探讨三柱截骨术（3-CO）治疗胸腰椎先天性脊柱侧后凸（CKS）患者冠状失平衡（CI）的发生率和危险因素。
背景资料概要
青少年特发性和退行性腰椎侧凸术后 CI 的发生率和危险因素已有报道。然而，3-CO 治疗 CKS 患者后的数据有限。
方法
我们回顾了一系列接受后路单纯 3-CO 的 CKS 患者。根据 C7 平移值的绝对值，将冠状曲线模式分为：A 型，C7 平移小于 30mm；B 型，C7 平移大于或等于 30mm 且 C7 铅垂线（C7PL）移向主曲线凹侧；C 型，C7 平移大于或等于 30mm 且 C7PL 移向凸侧。CI 定义为两侧 C7 平移均大于或等于 30mm。根据末次随访时的 C7 平移值，患者分为不平衡组和平衡组。
结果
共纳入 130 例患者（平均年龄 17.7±5.2 岁），平均随访时间为 41.3±18.5 个月。末次随访时 26 例（20%）患者出现 CI。与平衡组相比，不平衡组术前 C 型模式比例较大，主弯矫正度较高，术前和术后最低置钉节段（LIV）倾斜度较大。多因素 logistic 回归分析显示，CI 的危险因素为术前 C 型模式、术前 LIV 倾斜度大于或等于 23.5°以及术后即刻 LIV 倾斜度大于或等于 12.3°。
结论
3-CO 治疗 CKS 患者后 CI 的发生率为 20%。术前 C 型模式、术前 LIV 倾斜度大于或等于 23.5°以及术后即刻 LIV 倾斜度大于或等于 12.3°与末次随访时 CI 相关。
证据等级
3 级
Zotero 插件