Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, 5/F, Professorial Block, 102 Pokfulam Road, Pokfulam, Hong Kong SAR, China.
Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho Kashihara City, Nara, 6348522, Japan.
Eur Spine J. 2021 Jul;30(7):2007-2019. doi: 10.1007/s00586-021-06807-2. Epub 2021 Mar 15.
To determine the factors associated with 6-week postoperative global coronal balance and delayed global coronal balance at 2-year follow-up after anterior spinal fusion for Lenke 5C curves.
A total of 124 consecutive Lenke 5C curves with minimum 2-year follow-up was studied. Radiographic parameters were studied preoperatively, 6 weeks postoperatively, and 2 years postoperatively. Coronal balance was measured by C7-CSVL and trunk shift < 20 mm. The study outcomes were patients with early coronal balance and those who had immediate imbalance but developed delayed balance. Multivariate regression analyses of associated factors were performed with cutoffs determined by receiver operating characteristic curve.
31.5% patients attained global coronal balance immediate postoperatively and 89.4% of the early imbalance cases showed spontaneous coronal balance at 2-year follow-up. Increased preoperative UIV tilt (OR 1.093; p = 0.026; 95% CI: 1.011-1.182) and reduced immediate postoperative RSH difference (OR 0.963; p = 0.015; 95% CI: 0.935-0.993) were associated with immediate postoperative balance. For those with immediate imbalance, larger preoperative major Cobb angle (OR 1.226; p = 0.047; 95% CI: 1.003-1.499), less preoperative C7-CSVL (OR 0.829; p = 0.016; 95% CI: 0.712-0.966), and less immediate postoperative LIV tilt (OR 0.728; p = 0.013; 95% CI: 0.567-0.934) were associated with 2-year coronal balance. There was significant improvement in function (p = 0.006), self-image (p = 0.039) and total score domains (p = 0.014) in immediate imbalance to 2-year balance and imbalance groups.
Successful balance is achieved with a parallel fusion mass when performing anterior spinal fusion for Lenke 5C curves. Patients should be reassured that most attain eventual coronal balance despite the early imbalance. Level of evidence Therapeutic III.
确定与 Lenke 5C 型脊柱前路融合术后 6 周时整体冠状面平衡和 2 年时延迟整体冠状面平衡相关的因素。
共研究了 124 例连续的 Lenke 5C 型脊柱侧弯，其最低随访时间为 2 年。术前、术后 6 周和术后 2 年进行影像学参数研究。通过 C7-CSVL 和躯干偏移<20mm 来测量冠状面平衡。研究结果为早期冠状面平衡的患者和即刻不平衡但出现延迟平衡的患者。使用接收器工作特征曲线确定的截断值进行与相关因素的多变量回归分析。
31.5%的患者术后即刻获得整体冠状面平衡，89.4%的早期不平衡病例在 2 年随访时出现自发性冠状面平衡。术前 UIV 倾斜增加（OR 1.093;p=0.026;95%CI:1.011-1.182）和即刻术后 RSH 差值减少（OR 0.963;p=0.015;95%CI:0.935-0.993）与即刻术后平衡相关。对于即刻不平衡的患者，较大的术前主要 Cobb 角（OR 1.226;p=0.047;95%CI:1.003-1.499）、较小的术前 C7-CSVL（OR 0.829;p=0.016;95%CI:0.712-0.966）和较小的即刻术后 LIV 倾斜（OR 0.728;p=0.013;95%CI:0.567-0.934）与 2 年冠状面平衡相关。在即刻不平衡至 2 年平衡和不平衡组中，功能（p=0.006）、自我形象（p=0.039）和总分域（p=0.014）均有显著改善。
在进行 Lenke 5C 型脊柱前路融合术时，当融合质量平行时可实现平衡。应该让患者放心，尽管存在早期不平衡，但大多数患者最终都能达到冠状面平衡。
治疗性 III 级。
