使用支点弯曲位片选择最低固定椎可使 Lenke 1A 和 2A 型曲线的融合段更短且更安全，优于选择最后一个“实质性”触碰到的椎体。
Selection of Lowest Instrumented Vertebra Using Fulcrum Bending Radiographs Achieved Shorter Fusion Safely Compared With the Last "Substantially" Touching Vertebra in Lenke Type 1A and 2A Curves.
机构信息
Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
出版信息
Spine (Phila Pa 1976). 2019 Dec 15;44(24):E1419-E1427. doi: 10.1097/BRS.0000000000003182.
STUDY DESIGN
Retrospective study with prospective radiographic data collection.
OBJECTIVE
To compare fusion level determination criteria using the fulcrum bending radiograph (FBR) and the last substantially touched vertebra (STV) as the lowest instrumented vertebra (LIV) in the radiographic outcomes of correction surgery for Lenke 1A and 2A scoliosis patients with a minimum of 2-year follow-up.
SUMMARY OF BACKGROUND DATA
The STV has been proposed as the LIV in Lenke 1A and 2A curves to avoid postoperative distal adding-on. However, the influence of the inherent flexibility of the curves on selecting the LIV in relation to the STV is not known.
METHODS
A total of 65 consecutive Lenke 1A and 2A patients who underwent posterior selective thoracic fusion were included in this study with a minimum of 2-year follow-up. LIV determination was compared with the FBR and STV methods. The curve correction, trunk shift, radiographic shoulder height, list, and the incidence of distal adding-on were documented.
RESULTS
Mean preoperative, postoperative, and final follow-up standing coronal Cobb angles of primary curves were 59.37°, 15.58°, and 16.62° respectively. Using the FBR to determine the LIV, STV was selected in 16 patients (25%), STV-1 in 34 (52%), STV-2 in 11 (17%), and STV-3 in three (5%). Fusion level difference between using FBR and STV method was statistically significantly larger (P = 0.019) in patients with more than 70% fulcrum flexibility (mean: 1.18 levels, range: 0-3 levels) than those with less than or equal to 70% flexibility (mean: 0.70 level, range: -1 to 3 levels). Mean fulcrum flexibility was 73.9% in patients who achieved a shorter fusion by FBR method and 66.3% in patients who did not achieve a shorter fusion. Adding-on was observed in three patients (4.6%).
CONCLUSION
By considering the curve flexibility, LIV determination using FBR method achieved a shorter fusion than STV method in over 70% of Lenke 1A and 2A patients, while being safe and effective at 2-year follow-up.
LEVEL OF EVIDENCE
研究设计
回顾性研究，前瞻性影像学数据收集。
目的
比较使用枢轴弯曲位片（FBR）和最近触及的椎体（STV）作为最低固定椎体（LIV）的融合水平确定标准，以评估 Lenke 1A 和 2A 型脊柱侧凸患者矫形手术后的影像学结果，这些患者至少有 2 年的随访。
背景资料总结
STV 已被提议作为 Lenke 1A 和 2A 型曲线的 LIV，以避免术后远端附加。然而，目前尚不清楚曲线的固有柔韧性对选择与 STV 相关的 LIV 的影响。
方法
本研究共纳入 65 例连续接受后路选择性胸椎融合术的 Lenke 1A 和 2A 型患者，随访时间至少 2 年。比较 FBR 和 STV 方法确定 LIV。记录曲线矫正、躯干移位、影像学肩高、脊柱侧凸、后凸和远端附加的发生率。
结果
主要曲术前、术后和末次随访时的站立冠状 Cobb 角分别为 59.37°、15.58°和 16.62°。使用 FBR 确定 LIV 时，16 例（25%）选择 STV，34 例（52%）选择 STV-1，11 例（17%）选择 STV-2，3 例（5%）选择 STV-3。在具有超过 70%枢轴灵活性（平均：1.18 个节段，范围：0-3 个节段）的患者中，FBR 和 STV 方法之间的融合水平差异具有统计学意义（P=0.019），而在具有小于或等于 70%灵活性的患者中，融合水平差异无统计学意义（平均：0.70 个节段，范围：-1-3 个节段）。FBR 方法导致较短融合的患者的平均枢轴灵活性为 73.9%，而未实现较短融合的患者的平均枢轴灵活性为 66.3%。有 3 例（4.6%）患者出现附加现象。
结论
在超过 70%的 Lenke 1A 和 2A 型患者中，通过考虑曲线灵活性，使用 FBR 方法确定 LIV 比 STV 方法可获得更短的融合，且在 2 年随访时安全有效。
证据等级
3。
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