Uehara Masashi, Takahashi Jun, Ikegami Shota, Kuraishi Shugo, Futatsugi Toshimasa, Oba Hiroki, Takizawa Takashi, Munakata Ryo, Koseki Michihiko, Kato Hiroyuki
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi, Matsumoto.
Faculty of Textile Science and Technology, Shinshu University, Tokida, Ueda, Nagano, Japan.
Clin Spine Surg. 2019 Mar;32(2):E112-E116. doi: 10.1097/BSD.0000000000000736.
This is a retrospective single-center and single-surgeon study.
The present study examined for preoperative parameters having the highest correlation with compensatory thoracolumbar/lumbar (TL/L) curve correction 2 years after surgery in adolescent idiopathic scoliosis (AIS) patients with Lenke type 1 curves.
Several parameters have been considered to evaluate the flexibility of compensatory TL/L curve in AIS patients with Lenke type 1 curves. However, the imaging position with the strongest correlation with postoperative spontaneous TL/L curve correction is unknown.
In total, 37 patients with AIS Lenke type 1 curves who had undergone skip pedicle screw fixation were followed for a 2-year period were enrolled.
TL/L Cobb angles measured at the standing posteroanterior view, supine position, supine position with maximum bending, supine position with traction, prone position, and prone-push position were determined before surgery. Using TL/L Cobb angles determined 2 years postoperatively, correlations between preoperative and postoperative Cobb angles were calculated for each position using the Spearman rank-correlation coefficient, linear regression analysis, and paired t tests.
Mean preoperative mean±SD TL/L Cobb angle was significantly improved from 31±9 to 13±8 degrees at the study end point. In analyses of correlations between postoperative TL/L Cobb angle and preoperative parameters, the supine position with traction was most strongly associated with TL/L curve correction rate at 2 years after surgery (r=0.72; P<0.01), with paired t tests revealing a significant mean difference of 3.1 degrees.
Preoperative Cobb angle evaluated at the supine position with traction had the strongest correlation with spontaneously corrected TL/L curve Cobb angle after selective thoracic fusion for AIS Lenke type 1 curves. Accordingly, it may be sufficient to evaluate TL/L curve correction at this position only to reduce radiation exposure and operative time.
这是一项回顾性单中心、单术者研究。
本研究调查了青少年特发性脊柱侧凸（AIS）Lenke 1型曲线患者术后2年与代偿性胸腰段/腰段（TL/L）曲线矫正相关性最高的术前参数。
已有多个参数被用于评估AIS Lenke 1型曲线患者代偿性TL/L曲线的柔韧性。然而，与术后TL/L曲线自发矫正相关性最强的成像位置尚不清楚。
共纳入37例接受跳跃式椎弓根螺钉固定的AIS Lenke 1型曲线患者，随访2年。
术前测定站立位正位、仰卧位、最大弯曲仰卧位、牵引仰卧位、俯卧位和俯卧推位时的TL/L Cobb角。使用术后2年测定的TL/L Cobb角，通过Spearman等级相关系数、线性回归分析和配对t检验计算每个位置术前和术后Cobb角之间的相关性。
在研究终点，术前平均±标准差TL/L Cobb角从31±9度显著改善至13±8度。在术后TL/L Cobb角与术前参数的相关性分析中，牵引仰卧位与术后2年的TL/L曲线矫正率相关性最强（r = 0.72；P < 0.01），配对t检验显示平均差异为3.1度，具有显著性。
对于AIS Lenke 1型曲线，选择性胸椎融合术后，牵引仰卧位评估的术前Cobb角与自发矫正的TL/L曲线Cobb角相关性最强。因此，仅在该位置评估TL/L曲线矫正可能足以减少辐射暴露和手术时间。
