后路选择性胸腰段/腰椎融合术后 Lenke 5C 型青少年特发性脊柱侧凸患者的矢状面平衡。
Sagittal Alignment Profile Following Selective Thoracolumbar/Lumbar Fusion in Patients With Lenke Type 5C Adolescent Idiopathic Scoliosis.
机构信息
Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan.
出版信息
Spine (Phila Pa 1976). 2019 Sep 1;44(17):1193-1200. doi: 10.1097/BRS.0000000000003043.
STUDY DESIGN
A retrospective case series.
OBJECTIVE
This study aimed to report the sagittal outcome measures in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS) undergoing thoracolumbar/lumbar (TL/L) fusion surgery.
SUMMARY OF BACKGROUND DATA
Previous studies have demonstrated coronal correction of Lenke type 5C AIS by selective TL/L fusion surgery. However, little is known about the sagittal influence of selective TL/L curve correction in Lenke type 5C AIS.
METHODS
Thirty-nine patients with Lenke type 5C AIS underwent selective posterior TL/L curves fusion (mean age, 15.9 ± 2.1 yrs). Preoperative and postoperative radiographic and clinical parameters were analyzed at a minimum 2-year follow-up period. Radiographic parameters were compared between patients with Lenke sagittal modifier normal (Group N) to those with Lenke sagittal modifier minus (Group M).
RESULTS
The main TL/L Cobb angle was 46.3° ± 7.7° preoperatively and 20.7° ± 5.3° (P < 0.0001) at 2-year follow-up. Also, thoracic kyphosis (TK) (T1-12) angle was 29.0° ± 11.3° preoperatively and 36.4° ± 10.3° at follow-up (P < 0.001), and TK (T5-12) angle was 18.1° ± 10.2° preoperatively and 25.9° ± 8.9° at follow-up (P < 0.001). The cervical lordosis (CL) was 9.6° ± 11.6° preoperatively and 6.1° ± 10.9° at follow-up (P = 0.037). Compared with the Lenke sagittal modifier groups, preoperative TK (T1-12), TK (T5-12), thoracolumbar kyphosis (TLK), and CL were significantly different from both the groups; and after the surgery, no significant differences in these parameters were observed between the two groups.
CONCLUSION
After the selective TL/L posterior fusion surgery in patients with Lenke type 5C AIS, the sagittal alignment profile, including TK, TLK, C7 sagittal vertical axis, T1 slope, and CL, was significantly changed. With regard to the sagittal aspect, selective TL/L surgery was more likely to affect Group M than Group N.
LEVEL OF EVIDENCE
研究设计
回顾性病例系列研究。
目的
本研究旨在报告 Lenke 5C 型青少年特发性脊柱侧凸（AIS）患者行胸腰/腰椎（TL/L）融合术后的矢状位结果测量值。
背景资料概要
先前的研究已经证明了选择性 TL/L 融合手术可以矫正 Lenke 5C 型 AIS 的冠状面。然而，对于 Lenke 5C 型 AIS 中选择性 TL/L 曲线矫正的矢状面影响知之甚少。
方法
39 例 Lenke 5C 型 AIS 患者接受选择性后路 TL/L 曲线融合（平均年龄 15.9±2.1 岁）。在至少 2 年的随访期内，对术前和术后的影像学和临床参数进行分析。将 Lenke 矢状面修正正常（组 N）和 Lenke 矢状面修正负数（组 M）患者的影像学参数进行比较。
结果
主要 TL/L Cobb 角术前为 46.3°±7.7°，术后 2 年随访时为 20.7°±5.3°（P＜0.0001）。同样，术前胸腰椎后凸角（TK）（T1-12）为 29.0°±11.3°，随访时为 36.4°±10.3°（P＜0.001），术前 T5-12 段胸椎后凸角为 18.1°±10.2°，随访时为 25.9°±8.9°（P＜0.001）。颈椎前凸角（CL）术前为 9.6°±11.6°，随访时为 6.1°±10.9°（P=0.037）。与 Lenke 矢状面修正组相比，术前 TK（T1-12）、TK（T5-12）、胸腰椎后凸角（TLK）和 CL 均有显著差异；术后两组间这些参数无明显差异。
结论
在 Lenke 5C 型 AIS 患者行选择性 TL/L 后路融合术后，矢状位排列，包括 TK、TLK、C7 矢状位垂直轴、T1 斜率和 CL，均有显著改变。在矢状面方面，选择性 TL/L 手术更可能影响组 M 而非组 N。
证据水平
4 级。
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