选择最后一个实质性接触的椎体作为 Lenke 2A-R 和 2A-L 型曲线中的最低置钉椎体。
Selecting the Last Substantially Touching Vertebra as Lowest Instrumented Vertebra in Lenke type 2A-R and 2A-L Curves.
机构信息
Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
出版信息
Spine (Phila Pa 1976). 2020 Mar 1;45(5):309-318. doi: 10.1097/BRS.0000000000003254.
STUDY DESIGN
A retrospective study.
OBJECTIVE
The aim of this study was to determine whether the last substantially touching vertebra (LSTV) can be selected as the optimal lowest instrumented vertebra (LIV) for Lenke 2A adolescent idiopathic scoliosis (AIS) with different lumbar modifiers (2A-R and 2A-L) and to investigate its relationship with the distal adding-on.
SUMMARY OF BACKGROUND DATA
Previous studies have documented good outcomes in Lenke 1A curve when LSTV was selected as LIV.
METHODS
A total of 101 female patients were included with a minimum of 2-year follow-up after selective posterior surgery. Patients were classified on the basis of the direction of L4 tilt: 2A-L and 2A-R. Patients with LSTV-1, LSTV, or LSTV+1 selected as LIV were assigned to three groups. Factors associated with adding-on were analyzed through comparison among the three groups.
RESULTS
The level of LSTV was more distal in the 2A-R group than that in the 2A-L group (P = 0.011). Distal adding-on was observed in 24 patients (23.8%). In the 2A-R curves, 26.1% patients were found to have adding-on. The incidence of adding-on was significantly higher in LSTV-1 than LSTV or LSTV+1 group. Logistic regression analysis showed the distance between LIV and LSTV (LIV-LSTV <0) was the independent factor associated with adding-on (odds ratio [OR] = 8.7, 95% confidence interval [CI] = 3.1-45.5, P = 0.011). In the 2A-L curves, 21.8% patients were found to have adding-on. The incidence of adding-on was significantly lower in LSTV+1 than LSTV-1 or LSTV group. Similarly, logistic regression showed the distance between LIV and LSTV (LIV-LSTV ≤0) had significant association with adding-on (OR = 11.9, 95% CI = 2.5-53.2, P = 0.009).
CONCLUSION
The distance between LIV and LSTV was a significant factor associated with adding-on for both 2A-R and 2A-L patients. The rule of selecting LIV should be different between 2A-R and 2A-L curves. We recommend to extend the fusion level to LSTV in 2A-R curve and to LSTV+1 in 2A-L curve to avoid distal adding-on.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
本研究旨在确定对于不同腰椎修正型（2A-R 和 2A-L）Lenke 2A 青少年特发性脊柱侧凸（AIS）患者，最后实质性触及的椎体（LSTV）是否可作为最优的最低置钉椎体（LIV），并探讨其与附加延伸的关系。
背景资料概要
先前的研究已经证明，当选择 LSTV 作为 LIV 时，Lenke 1A 曲线的治疗效果良好。
方法
共纳入 101 例女性患者，所有患者均在选择性后路手术后至少随访 2 年。根据 L4 倾斜方向对患者进行分类：2A-L 和 2A-R。将 LSTV-1、LSTV 或 LSTV+1 选择为 LIV 的患者分为三组。通过对三组进行比较，分析与附加延伸相关的因素。
结果
2A-R 组的 LSTV 水平明显比 2A-L 组更靠远（P=0.011）。在 24 例患者中观察到了附加延伸（23.8%）。在 2A-R 曲线上，26.1%的患者存在附加延伸。LSTV-1 组的附加延伸发生率明显高于 LSTV 或 LSTV+1 组。Logistic 回归分析显示，LIV 与 LSTV 之间的距离（LIV-LSTV<0）是与附加延伸相关的独立因素（比值比[OR] = 8.7，95%置信区间[CI] = 3.1-45.5，P=0.011）。在 2A-L 曲线上，21.8%的患者存在附加延伸。LSTV+1 组的附加延伸发生率明显低于 LSTV-1 或 LSTV 组。同样，Logistic 回归显示，LIV 与 LSTV 之间的距离（LIV-LSTV≤0）与附加延伸显著相关（OR=11.9，95%CI=2.5-53.2，P=0.009）。
结论
对于 2A-R 和 2A-L 患者，LIV 与 LSTV 之间的距离是与附加延伸相关的重要因素。2A-R 和 2A-L 曲线的 LIV 选择规则应该有所不同。我们建议在 2A-R 曲线上将融合水平延伸至 LSTV，在 2A-L 曲线上延伸至 LSTV+1，以避免远端附加延伸。
证据水平
3。
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