后路手术治疗 Lenke1 和 2 型特发性脊柱侧凸术后的颈部倾斜：一种新的预测指标。
Postoperative neck tilt in Lenke 1 and 2 AIS patients after correction surgery: a novel predictive index.
机构信息
Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Department of Orthopedics, Shanghai 10th people's hospital, Tongji University, Shanghai, People's Republic of China.
出版信息
BMC Musculoskelet Disord. 2019 Sep 4;20(1):405. doi: 10.1186/s12891-019-2792-9.
BACKGROUND
Postoperative neck tilt (PNT) is a phenomenon in adolescent idiopathic scoliosis (AIS) patients which is distinct form shoulder imbalance. There were scarce studies performed to explore the risk factors for PNT in Lenke 1 and 2 AIS patients, and whether it can be predicted after surgery remains unknown. The objective of this study is to explore the prevalence and risk factors for PNT, and introduce an index for prediction of PNT in Lenke 1 and 2 AIS patients after correction surgery.
METHODS
Medical records of Lenke 1 and 2 AIS patients who received correction surgery were reviewed from February 2013 to February 2015. Posteroanterior films were evaluated before surgery and at 2 years' follow-up. Patients were divided into two groups according to whether PNT occurred at the 2 years' follow-up. Risk factors of PNT were analyzed, and PNT Index was proposed and verified.
RESULTS
One hundred two Lenke 1 and 2 AIS patients were recruited in this study. The prevalence of PNT after correction was 40.2%. According to the postoperative CAT (Cervical Axis Tilt), patients were divided into two group: PNT group (CAT≧5°, n = 41) and non-PNT group (CAT< 5°, n = 61). Postoperative T1 tilt, preoperative proximal thoracic curve (PTC), postoperative PTC and postoperative coronal balance (CB) were significantly different between two groups. Logistic regression showed that postoperative PTC and postoperative CB were the primary risk factors for PNT, which could be predicted by the regression equation: PNT Index = 1.1 x postoperative PTC (degrees) - 0.9 x postoperative CB (millimeters). On the basis of ROC curve, if PNT Index was more than 10, the occurrence rate of PNT was 86%. On the contrary, the rate of no PNT phenomenon was 80%.
CONCLUSION
Postoperative PTC and postoperative CB were the important factors for PNT in Lenke 1 and 2 AIS patients. Sufficient correction of PTC and moderate correction of CB should be recommended when operating on Lenke1 and 2 AIS patients.
背景
术后颈倾（PNT）是青少年特发性脊柱侧凸（AIS）患者的一种独特现象，与肩部不平衡不同。目前针对 Lenke 1 和 2 型 AIS 患者 PNT 的危险因素进行的研究很少，且术后是否可以预测 PNT 仍然未知。本研究旨在探讨 PNT 的发生率和危险因素，并引入一个预测 Lenke 1 和 2 型 AIS 患者术后 PNT 的指数。
方法
回顾了 2013 年 2 月至 2015 年 2 月接受矫形手术的 Lenke 1 和 2 型 AIS 患者的病历。术前和 2 年随访时拍摄后前位片。根据术后 2 年随访时是否发生 PNT 将患者分为两组。分析 PNT 的危险因素，并提出并验证 PNT 指数。
结果
本研究共纳入 102 例 Lenke 1 和 2 型 AIS 患者。矫正后 PNT 的发生率为 40.2%。根据术后 CAT（颈椎倾斜），患者分为 PNT 组（CAT≧5°，n=41）和非 PNT 组（CAT<5°，n=61）。两组间术后 T1 倾斜、术前近端胸椎曲度（PTC）、术后 PTC 和术后冠状平衡（CB）差异有统计学意义。Logistic 回归显示，术后 PTC 和术后 CB 是 PNT 的主要危险因素，可通过回归方程预测：PNT 指数=1.1x术后 PTC（度）-0.9x术后 CB（毫米）。基于 ROC 曲线，如果 PNT 指数大于 10，则 PNT 的发生率为 86%。相反，无 PNT 现象的发生率为 80%。
结论
术后 PTC 和术后 CB 是 Lenke 1 和 2 型 AIS 患者 PNT 的重要因素。对 Lenke1 和 2 型 AIS 患者进行手术时，应推荐充分矫正 PTC 和适度矫正 CB。
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