Kuroya Shingo, Akazawa Tsutomu, Kotani Toshiaki, Sakuma Tsuyoshi, Minami Shohei, Torii Yoshiaki, Umehara Tasuku, Iinuma Masahiro, Murakami Kenichi, Orita Sumihisa, Inage Kazuhide, Eguchi Yawara, Fujimoto Kazuki, Shiga Yasuhiro, Nakamura Junichi, Inoue Gen, Miyagi Masayuki, Saito Wataru, Ohtori Seiji, Niki Hisateru
Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan.
Asian Spine J. 2019 May 14;13(5):793-800. doi: 10.31616/asj.2018.0206. Print 2019 Oct.
A retrospective cohort study.
This study aims to investigate postoperative shoulder imbalance (PSI) ≥5 years postoperatively in patients who underwent posterior spinal fusion using hooks at the upper instrumented vertebra (UIV) for Lenke type 1 adolescent idiopathic scoliosis (AIS).
Studies have reported PSI due to excessive correction of the main thoracic curve.
We examined 56 patients with AIS who underwent a posterior spinal fusion with hooks at the UIV from 2004 to 2010. Of these, we enrolled 14 patients who underwent surgery, at least, 5 years ago. X-rays and Scoliosis Research Society-22 (SRS-22) questionnaire were administered. To evaluate the shoulder balance, T1 vertebral tilt angle (T1 tilt), clavicle angle, and radiographic shoulder height (RSH) were measured. PSI was considered as the absolute value of the postoperative RSH being ≥20 mm. Based on radiographs obtained immediately postoperatively, we divided patients into two groups as follows: the balanced group (absolute value of RSH <20 mm) and imbalanced group (absolute value of RSH ≥20 mm).
The frequency of PSI was 28.6% immediately postoperatively, 0% 2 years postoperatively, and 7.1% at the last follow-up. In the balanced group, PSI did not occur even at 2 years postoperatively or at the last follow-up. In the imbalanced group, PSI was improved in all patients 2 years postoperatively and all patients, except one patient, at the last follow-up. No significant differences were noted in the frequency of distal adding-on at 2 years postoperatively or the last follow-up between the balanced group and the imbalanced group. We observed moderate negative correlations between the absolute value of T1 tilt and the SRS-22 pain and satisfaction at the last follow-up.
Hooks at the UIV could adjust the shoulder balance to avoid long-term PSI in patients with AIS.
一项回顾性队列研究。
本研究旨在调查接受上固定椎（UIV）钩形后路脊柱融合术治疗Lenke 1型青少年特发性脊柱侧凸（AIS）的患者术后≥5年的肩部失衡（PSI）情况。
已有研究报道因胸主弯过度矫正导致的PSI。
我们检查了2004年至2010年间接受UIV钩形后路脊柱融合术的56例AIS患者。其中，我们纳入了至少在5年前接受手术的14例患者。进行了X线检查和脊柱侧凸研究学会-22（SRS-22）问卷调查。为评估肩部平衡，测量了T1椎体倾斜角（T1倾斜）、锁骨角和影像学肩部高度（RSH）。PSI定义为术后RSH绝对值≥20 mm。根据术后即刻获得的X线片，我们将患者分为以下两组：平衡组（RSH绝对值<20 mm）和失衡组（RSH绝对值≥20 mm）。
术后即刻PSI发生率为28.6%，术后2年为0%，末次随访时为7.1%。在平衡组中，术后2年及末次随访时均未发生PSI。在失衡组中，所有患者术后2年PSI均有改善，末次随访时除1例患者外所有患者PSI均有改善。平衡组和失衡组术后2年及末次随访时远端附加现象的发生率无显著差异。我们观察到末次随访时T1倾斜绝对值与SRS-22疼痛和满意度之间存在中度负相关。
UIV钩可调节肩部平衡，避免AIS患者出现长期PSI。
