Brooks Jaysson T, Bastrom Tracey P, Bartley Carrie E, Lonner Baron S, Shah Suken A, Miyanji Firoz, Asghar Jahangir, Newton Peter O, Yaszay Burt
Children's of Mississippi, University of Mississippi Medical Center, 2500 N State St, Jackson, MS 39216, USA.
Rady Children's Hospital, 7910 Frost Street, San Diego, CA 92123, USA.
Spine Deform. 2018 Nov-Dec;6(6):707-711. doi: 10.1016/j.jspd.2018.03.010.
Multicenter review of prospectively collected data.
The purpose of this study was to evaluate whether a UIV of T2 reliably results in level shoulders postoperatively.
Adolescent idiopathic scoliosis (AIS) patients with a risk of a high left shoulder postoperatively are generally recommended to have instrumentation to T2, those with neutral shoulders a T3 UIV, and those with an elevated right shoulder are recommended a UIV of T4 or below in order to achieve postoperative shoulder balance.
A prospective, multicenter AIS database was queried for subjects with minimum two-year follow-up who underwent posterior spinal fusion to correct their main thoracic deformity. Subjects were grouped based on their proximal fusion level. A high shoulder was defined as >1 cm difference on radiographs.
A total of 626 subjects met inclusion criteria and were divided by UIVs of T2 189, T3 205, and T4 232. Preoperatively, the groups had similar rates of balanced shoulders (T2 47%, T3 49%, T4 45%) and high left shoulders (T2 8.5%, T3 8.8%, and T4 7.3%). Postoperatively, there was a greater percentage of postoperative shoulder imbalance for T2 (45%) and T3 (48%) UIV groups as compared to T4 (34%, p = .008). As expected, the T2 (46%) and T3 (49%) groups had significantly better upper thoracic curve correction as compared to the T4 group (42%, p < .001).
The selection of a T4 UIV results in more shoulder balance postoperatively than T2 or T3, regardless of which shoulder was elevated preoperatively. The selection of a T2 UIV does not guarantee postoperative shoulder balance following posterior treatment of main thoracic curves; however, when compared to the more caudal UIV of T4, an improved upper thoracic curve correction can be anticipated.
Level 3.
对前瞻性收集的数据进行多中心回顾。
本研究的目的是评估T2作为上终椎（UIV）是否能可靠地使术后双肩水平。
对于术后有高左肩风险的青少年特发性脊柱侧凸（AIS）患者，一般建议固定至T2；双肩中立的患者固定至T3作为上终椎；右肩抬高的患者建议上终椎为T4或更低，以实现术后肩部平衡。
对一个前瞻性、多中心AIS数据库进行查询，选取接受后路脊柱融合术矫正主胸弯且随访至少两年的患者。根据近端融合水平对患者进行分组。高肩定义为X线片上双肩相差>1 cm。
共有626名患者符合纳入标准，根据上终椎分为T2组189例、T3组205例和T4组232例。术前，各组双肩平衡率（T2组47%，T3组49%，T4组45%）和高左肩率（T2组8.5%，T3组8.8%，T4组7.3%）相似。术后，与T4组（34%，p = .008）相比，T2组（45%）和T3组（48%）术后肩部失衡的百分比更高。正如预期的那样，与T4组（42%，p < .001）相比，T2组（46%）和T3组（49%）上胸弯矫正效果明显更好。
无论术前哪侧肩部抬高，选择T4作为上终椎术后肩部平衡效果优于T2或T3。选择T2作为上终椎不能保证主胸弯后路治疗后术后肩部平衡；然而，与更靠下的T4作为上终椎相比，可以预期上胸弯矫正效果更好。
3级。
