The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
Rady Children's Hospital-San Diego, San Diego, CA, USA.
Spine Deform. 2021 Mar;9(2):451-460. doi: 10.1007/s43390-020-00236-9. Epub 2020 Nov 17.
AIS patients consider shoulder balance an important cosmetic outcome after surgery. We examined the impact of preoperative left shoulder elevation (LSE) and choice of upper instrumented vertebra (UIV) on postoperative shoulder imbalance (PostSI).
This was a retrospective cohort study utilizing a prospective AIS database. Patients had Lenke type 1-4 curves and preoperative shoulder height ≥ 1.0 cm. Patients with preoperative LSE and right shoulder elevation (RSE) were compared. Shoulder height difference < 1 cm was considered 'mild', 1-2 cm was 'moderate', and ≥ 2.0 cm was 'severe'.
407 patients had ≥ 1.0 cm imbalance preoperatively, with 88 (21.6%) LSE. There were no differences in gender (p = 0.855) or age (p = 0.477). Patients with LSE more frequently had Lenke type 2 curves (43.2% vs 16.3%, p < 0.001), while preoperative RSE averaged 1.9 ± 0.9 cm versus 1.6 ± 0.5 cm for LSE (p < 0.001). Those with LSE more often had severe PostSI at 2 years (30.7% vs 5.0%, p < 0.001), and only 26.1% of patients with severe preoperative LSE corrected to mild. In contrast, most patients with RSE had mild PostSI regardless of initial imbalance. When examining only LSE patients, there was no difference in preoperative SH by final UIV (p = 0.101). Further, UIV choice did not impact the proportion of severely unbalanced patients postoperatively (p = 0.446). A PTC > 34.5° was predictive of PostSI ≥ 2.0 cm for patients with preoperative LSE.
AIS patients with preoperative LSE are less likely to achieve level shoulders postoperatively. Choice of higher UIV did not affect postoperative shoulder imbalance in this cohort. A PTC > 34.5° was predictive of severe PostSI in patients with preoperative LSE.
II.
AIS 患者术后将肩部平衡视为重要的美容结果。我们研究了术前左侧肩部抬高（LSE）和上置椎选择对术后肩部不平衡（PostSI）的影响。
这是一项回顾性队列研究，利用前瞻性 AIS 数据库。患者具有 Lenke 1-4 型曲线，术前肩高≥1.0cm。比较术前 LSE 伴右肩抬高（RSE）和无 LSE 伴右肩抬高（NRSE）患者。肩部高度差＜1cm 为“轻度”，1-2cm 为“中度”，≥2cm 为“重度”。
407 例患者术前存在≥1.0cm 的不平衡，其中 88 例（21.6%）有 LSE。两组在性别（p=0.855）或年龄（p=0.477）方面无差异。有 LSE 的患者更常伴有 Lenke 2 型曲线（43.2%比 16.3%，p＜0.001），而术前 RSE 平均为 1.9±0.9cm，LSE 为 1.6±0.5cm（p＜0.001）。有 LSE 的患者术后更易出现重度 PostSI（30.7%比 5.0%，p＜0.001），而术前重度 LSE 患者中仅 26.1%可矫正至轻度。相比之下，大多数 RSE 患者无论初始不平衡程度如何，术后均为轻度 PostSI。仅检查 LSE 患者时，末次 UIV 与术前 SH 无差异（p=0.101）。此外，UIV 选择对术后严重失衡患者的比例无影响（p=0.446）。术前 LSE 患者 PTC＞34.5°是术后 PostSI≥2cm 的预测因素。
术前有 LSE 的 AIS 患者术后肩部更不易平衡。本队列中，较高的 UIV 选择并不影响术后肩部不平衡。术前 LSE 患者的 PTC＞34.5°是重度 PostSI 的预测因素。
II 级。
