Moorthy Vikaesh, Goh Graham S, Guo Chang-Ming, Tan Seang-Beng, Chen John Li-Tat, Soh Reuben Chee Cheong
Yong Loo Lin School of Medicine, National University Singapore.
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
Clin Spine Surg. 2022 Feb 1;35(1):E137-E142. doi: 10.1097/BSD.0000000000001153.
This is a retrospective study.
To determine (1) the independent risk factors of postoperative shoulder imbalance (PSI) after adolescent idiopathic scoliosis (AIS) correction surgery; and (2) whether the level of upper instrumented vertebrae (UIV) affects postoperative shoulder balance.
PSI is an important outcome of AIS correction surgery as it influences a patient's appearance and satisfaction. However, risk factors for PSI remain controversial and there are currently no studies evaluating the effect of sagittal spinopelvic parameters on PSI. Previous studies on the relationship between the level of UIV and PSI have also reported conflicting results.
Sixty-nine AIS patients undergoing correction surgery at a single institution were retrospectively reviewed. Radiographic parameters were measured on anteroposterior and lateral x-rays preoperatively, immediate postoperatively, and 12 months postoperatively. At 1 year follow-up, patients were divided into 2 groups based on their radiographic shoulder height (RSH): (1) PSI group (RSH ≥20 mm) and (2) non-PSI group (RSH <20 mm).
On multivariate regression analysis, a lower postoperative main thoracic curve (MTC) [odds ratio (OR): 0.702, 95% confidence interval (CI): 0.519-0.949, P=0.022], greater percentage correction of MTC (OR: 1.526, 95% CI: 1.049-2.220, P=0.027) and higher postoperative sacral slope (OR: 1.364, 95% CI: 1.014-1.834, P=0.040) were identified as independent risk factors of PSI. When preoperative, postoperative, and absolute change in shoulder parameters were compared across the level of UIV, no significant differences were found regardless of the radiographic shoulder parameter analyzed.
Lower postoperative MTC, greater percentage correction of MTC and higher postoperative sacral slope were independent risk factors of PSI. Shoulder balance and symmetry were not affected by the level of UIV selected. Relative curve correction is a more important consideration than UIV to avoid PSI after AIS correction surgery.
III.
这是一项回顾性研究。
确定（1）青少年特发性脊柱侧凸（AIS）矫正手术后肩部失衡（PSI）的独立危险因素；以及（2）上固定椎（UIV）水平是否影响术后肩部平衡。
PSI是AIS矫正手术的一项重要结果，因为它会影响患者的外观和满意度。然而，PSI的危险因素仍存在争议，目前尚无研究评估矢状位脊柱骨盆参数对PSI的影响。以往关于UIV水平与PSI之间关系的研究也报告了相互矛盾的结果。
对在单一机构接受矫正手术的69例AIS患者进行回顾性分析。在术前、术后即刻和术后12个月的前后位和侧位X线片上测量影像学参数。在1年随访时，根据患者的影像学肩部高度（RSH）将其分为两组：（1）PSI组（RSH≥20 mm）和（2）非PSI组（RSH<20 mm）。
多因素回归分析显示，术后胸主弯（MTC）较低[比值比（OR）：0.702，95%置信区间（CI）：0.519 - 0.949，P = 0.022]、MTC矫正百分比更高（OR：1.526，95% CI：1.049 - 2.220，P = 0.027）以及术后骶骨斜率更高（OR：1.364，95% CI：1.014 - 1.834，P = 0.040）被确定为PSI的独立危险因素。当比较不同UIV水平的术前、术后肩部参数及绝对变化时，无论分析何种影像学肩部参数，均未发现显著差异。
术后较低的MTC、较高的MTC矫正百分比和较高的术后骶骨斜率是PSI的独立危险因素。肩部平衡和对称性不受所选UIV水平的影响。在AIS矫正手术后，相对曲线矫正比UIV更重要，是避免PSI的关键因素。
III级
