后路矫形融合术后结构性胸腰段/腰椎曲度患者下位固定椎以下椎间盘楔变角和椎体倾斜角：至少 5 年随访结果
Disc Wedge and Vertebral Body Tilt Angle Below Lower Instrumented Vertebra After Posterior Correction and Fusion in Patients With a Structural Thoracolumbar/Lumbar Curve: A Minimum 5-Year Follow-up.
机构信息
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
Spine (Phila Pa 1976). 2019 Dec 15;44(24):E1436-E1442. doi: 10.1097/BRS.0000000000003164.
STUDY DESIGN
A retrospective cohort study.
OBJECTIVE
The purpose of this study was to evaluate the stability of remained lumbar curve by the review of serial changes in L3/L4 disc wedge and L4 body tilt angle in patients with idiopathic scoliosis who underwent posterior-only fusion to L3 lower instrumented vertebra (LIV) for the correction of structural thoracolumbar/lumbar (TL/L) curve for a minimum 5-year follow-up.
SUMMARY OF BACKGROUND DATA
There has been some debate in the selection of L3 or L4 as the LIV for the correction of structural TL/L curve. However, there is a limited information about the changes in disc wedge or vertebral body tilt angles below the L3 LIV.
METHODS
Forty-seven patients were included (mean age 16 yr 7 mo, follow-up 8 yr 2 mo). The Cobb angle of the TL/L curve, L3/L4 disc wedge angle, L4 tilt angle, trunk shift (TS), and apical vertebral translation (AVT) were compared preoperatively and at postoperative 5 days, 1 month, 6 months, 2 years, and final follow-up.
RESULTS
At postoperative 5 days, Cobb angle of the TL/L curve, L4 tilt angle, and AVT were improved, except TS and L3/L4 disc wedge angle. The L3/L4 disc wedge and L4 tilt angle were most increased at postoperative 6 months and decreased thereafter. L4 tilt angle, AVT, and TS were improved during postoperative follow-up, except L3/L4 disc wedge angle. Finally, Cobb angle of the TL/L curve (11.8° ± 5.1°, P < 0.001), L4 tilt angle (7.6° ± 4.0°, P < 0.001), AVT (19.2 ± 9.3 mm, P < 0.001), and TS (-5.0 ± 10.0 mm, P = 0.041) were improved; however, L3/L4 disc wedge angle (3.3° ± 2.3°, P = 0.442) was not improved compared to the preoperative evaluation.
CONCLUSION
When LIV was selected as the L3, the correction of TL/L curve was maintained in a minimum 5-year follow-up with the improvement of L4 tilt angle, AVT, and TS; however, L3/L4 disc wedge angle may remain.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
本研究旨在通过评估特发性脊柱侧凸患者后路仅融合至 L3 下固定椎（LIV）以矫正结构性胸腰椎/腰椎（TL/L）曲线的 L3/L4 椎间盘楔形角和 L4 体倾斜角的连续变化，来评价剩余腰椎曲线的稳定性。这些患者至少随访 5 年。
背景资料概要
在选择 L3 或 L4 作为 LIV 来矫正结构性 TL/L 曲线时，存在一些争议。然而，关于 L3 LIV 以下椎间盘楔形角或椎体倾斜角变化的信息有限。
方法
共纳入 47 例患者（平均年龄 16 岁 7 个月，随访 8 年 2 个月）。比较术前、术后 5 天、1 个月、6 个月、2 年和最终随访时 TL/L 曲线的 Cobb 角、L3/L4 椎间盘楔形角、L4 倾斜角、躯干偏移（TS）和顶椎偏移（AVT）。
结果
术后 5 天，TL/L 曲线的 Cobb 角、L4 倾斜角和 AVT 得到改善，而 TS 和 L3/L4 椎间盘楔形角没有改善。L3/L4 椎间盘楔形角和 L4 倾斜角在术后 6 个月时增加最多，此后逐渐减少。术后随访中，L4 倾斜角、AVT 和 TS 均得到改善，除 L3/L4 椎间盘楔形角外。最后，TL/L 曲线的 Cobb 角（11.8°±5.1°，P<0.001）、L4 倾斜角（7.6°±4.0°，P<0.001）、AVT（19.2±9.3mm，P<0.001）和 TS（-5.0±10.0mm，P=0.041）均得到改善；然而，与术前评估相比，L3/L4 椎间盘楔形角（3.3°±2.3°，P=0.442）没有改善。
结论
当 LIV 选择为 L3 时，在至少 5 年的随访中，TL/L 曲线的矫正得到维持，L4 倾斜角、AVT 和 TS 得到改善；然而，L3/L4 椎间盘楔形角可能仍然存在。
证据等级
3 级。
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