Department of Orthopaedic Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, 216-8511, Kawasaki, Kanagawa, Japan.
Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan.
Eur J Orthop Surg Traumatol. 2021 Feb;31(2):245-251. doi: 10.1007/s00590-020-02766-4. Epub 2020 Aug 16.
To clarify the impact of anchor type at upper instrumented vertebra (UIV) on postoperative shoulder imbalance in patients with Lenke type 1 adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion.
Subjects were 81 patients with Lenke type 1 AIS who underwent posterior spinal fusion between 2004 and 2013. Twenty-five patients agreed to participate in the study. We divided the patients into two groups: Hook group (15 patients with hooks at UIV who underwent surgery between 2004 and 2011) and PS group (ten patients with pedicle screws at UIV who underwent surgery between 2012 and 2013). To evaluate shoulder balance, first thoracic vertebra tilt angle (T1 tilt), clavicle angle (CA), and radiographic shoulder height (RSH) were measured.
There were no significant differences in preoperative T1 tilt, CA, or RSH between the both groups. The postoperative 1-week, 2-year, and most recently observed T1 tilts were significantly smaller in the Hook group than in the PS group. There were no significant differences in postoperative 1-week, 2-year, and most recently observed CAs between the two groups. Although there were no significant differences in 1-week postoperative RSH between the groups, the 2-year postoperative RSH was significantly smaller in the Hook group than in the PS group. The most recently observed RSH tended to be smaller in the Hook group than in the PS group, but the difference was not significant.
In the PS group, poor shoulder balance remained over the long term. The hooks at UIV adjusted postoperative shoulder balance.
明确在上位椎（UIV）使用不同的固定装置对接受后路脊柱融合术的 Lenke 1 型青少年特发性脊柱侧凸（AIS）患者术后肩部平衡的影响。
研究对象为 2004 年至 2013 年间接受后路脊柱融合术的 81 例 Lenke 1 型 AIS 患者。25 例患者同意参与本研究。我们将患者分为两组：钩组（15 例 UIV 使用钩的患者，手术时间为 2004 年至 2011 年）和 PS 组（10 例 UIV 使用椎弓根螺钉的患者，手术时间为 2012 年至 2013 年）。为评估肩部平衡，测量了第一胸椎倾斜角（T1 倾斜角）、锁骨角（CA）和影像学肩部高度（RSH）。
两组患者术前 T1 倾斜角、CA 或 RSH 均无显著差异。钩组患者术后 1 周、2 年和最近观察的 T1 倾斜角明显小于 PS 组。两组患者术后 1 周、2 年和最近观察的 CA 无显著差异。虽然两组患者术后 1 周的 RSH 无显著差异，但 PS 组患者的 2 年术后 RSH 明显小于钩组。最近观察到的 RSH 倾向于钩组小于 PS 组，但差异无统计学意义。
在 PS 组，肩部平衡在长期内仍然不佳。UIV 上的钩可调整术后肩部平衡。
