术后上节段椎体倾斜角（≥0°）阳性（+ve）显著增加 Lenke1 和 2 型青少年特发性脊柱侧凸患者的肩部和颈部内侧失衡风险。
A Positive (+ve) Postoperative Upper Instrumented Vertebra Tilt Angle (≥0°) Significantly Increases the Risk of Medial Shoulder and Neck Imbalance in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients.
机构信息
Department of Orthopaedic Surgery (NOCERAL), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
出版信息
Spine (Phila Pa 1976). 2020 Jun 15;45(12):E694-E703. doi: 10.1097/BRS.0000000000003407.
STUDY DESIGN
Retrospective study.
OBJECTIVE
To investigate the relationship between a +ve postoperative Upper Instrumented Vertebra (UIV) (≥0°) tilt angle and the risk of medial shoulder/neck and lateral shoulder imbalance among Lenke 1 and 2 Adolescent Idiopathic Scoliosis (AIS) patients following Posterior Spinal Fusion.
SUMMARY OF BACKGROUND DATA
Current UIV selection strategy has poor correlation with postoperative shoulder balance. The relationship between a +ve postoperative UIV tilt angle and the risk of postoperative shoulder and neck imbalance was unknown.
METHODS
One hundred thirty-six Lenke 1 and 2 AIS patients with minimum 2 years follow-up were recruited. For medial shoulder and neck balance, patients were categorized into positive (+ve) imbalance (≥+4°), balanced, or negative (-ve) imbalance (≤-4°) groups based on T1 tilt angle/Cervical Axis measurement. For lateral shoulder balance, patients were classified into +ve imbalance (≥+3°) balanced, and -ve imbalance (≤-3°) groups based on Clavicle Angle (Cla-A) measurement. Linear regression analysis identified the predictive factors for shoulder/neck imbalance. Logistic regression analysis calculated the odds ratio of shoulder/neck imbalance for patients with +ve postoperative UIV tilt angle.
RESULTS
Postoperative UIV tilt angle and preoperative T1 tilt angle were predictive of +ve medial shoulder imbalance. Postoperative UIV tilt angle and postoperative PT correction were predictive of +ve neck imbalance. Approximately 51.6% of patients with +ve medial shoulder imbalance had +ve postoperative UIV tilt angle. Patients with +ve postoperative UIV tilt angle had 14.9 times increased odds of developing +ve medial shoulder imbalance and 3.3 times increased odds of developing +ve neck imbalance. Postoperative UIV tilt angle did not predict lateral shoulder imbalance.
CONCLUSION
Patients with +ve postoperative UIV tilt angle had 14.9 times increased odds of developing +ve medial shoulder imbalance (T1 tilt angle ≥+4°) and 3.3 times increased odds of developing +ve neck imbalance (cervical axis ≥+4°).
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
探讨术后上椎弓根（UIV）（≥0°）倾斜角与 Lenke 1 和 2 型青少年特发性脊柱侧凸（AIS）患者后路脊柱融合术后内侧肩部/颈部和外侧肩部失衡风险之间的关系。
背景资料概要
目前的 UIV 选择策略与术后肩部平衡相关性较差。术后 UIV 倾斜角与术后肩部和颈部失衡风险之间的关系尚不清楚。
方法
共纳入 136 例 Lenke 1 和 2 型 AIS 患者，随访时间至少 2 年。对于内侧肩部和颈部平衡，根据 T1 倾斜角/颈椎轴测量值，将患者分为正性（+ve）失衡（≥+4°）、平衡和负性（-ve）失衡（≤-4°）组。对于外侧肩部平衡，根据锁骨角（Cla-A）测量值，将患者分为正性（+ve）失衡（≥+3°）、平衡和负性（-ve）失衡（≤-3°）组。线性回归分析确定了肩部/颈部失衡的预测因素。Logistic 回归分析计算了 UIV 术后正性倾斜角患者肩部/颈部失衡的比值比。
结果
术后 UIV 倾斜角和术前 T1 倾斜角是正性内侧肩部失衡的预测因素。术后 UIV 倾斜角和术后 PT 矫正与正性颈部失衡相关。约 51.6%的正性内侧肩部失衡患者存在 UIV 术后正性倾斜角。UIV 术后正性倾斜角的患者发生正性内侧肩部失衡的可能性增加 14.9 倍，发生正性颈部失衡的可能性增加 3.3 倍。术后 UIV 倾斜角与外侧肩部失衡无关。
结论
UIV 术后正性倾斜角的患者发生正性内侧肩部失衡（T1 倾斜角≥+4°）的可能性增加 14.9 倍，发生正性颈部失衡（颈椎轴≥+4°）的可能性增加 3.3 倍。
证据等级
4 级。
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