早发性脊柱侧凸后路融合术后肩部平衡的评估及与青少年特发性脊柱侧凸肩部平衡的比较。

Evaluation of shoulder balance in early onset scoliosis after definitive fusion and comparison with adolescent idiopathic scoliosis shoulder balance.

机构信息

Department of Orthopedics, SUNY Upstate Medical University, 750 E. Adams St., Syracuse, NY, 13210, USA.

Division of Orthopaedics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.

出版信息

Spine Deform. 2022 Jan;10(1):183-188. doi: 10.1007/s43390-021-00393-5. Epub 2021 Aug 4.

DOI:10.1007/s43390-021-00393-5

PMID:34347286

Abstract

STUDY DESIGN

The Children Spine Study Group registry was queried for early onset scoliosis (EOS) patients who had final definitive spinal fusion after their scoliosis was managed with either growing rods or VEPTR. The Harms Study Group registry was queried for adolescent idiopathic scoliosis (AIS) patients who had definitive fusion OBJECTIVE: The goal is to assess shoulder alignment in EOS patients after a definitive fusion and how these radiographic outcomes relate to the more familiar situation of post-definitive fusions shoulder alignment in AIS patients.

BACKGROUND

EOS is a challenging pathology to manage. Numerous components are important in the success of spinal surgery for this population. Shoulder balance is a one of the components that is easily seen by the patient. Recently, the importance of its relationship to patient satisfaction has received greater attention.

METHODS

Sample size: n = 145 (EOS (n = 34) and AIS (n = 111)). Shoulder balance parameters (SBP) of clavicular angle (CA), coracoid height difference (CHD), clavicular tilt angle difference (CTAD), and clavicle-rib cage intersection difference (CRID) measurements were measured from the reviewed radiographs and documented pre-definitive, post-definitive and 2-year follow-up measures. Shoulder balance parameters were compared between EOS and AIS cohorts at documented intervals.

RESULTS

EOS mean pre-definitive fusion SBPs (CA, CTAD, CRID, CHD) were significantly higher compared to AIS, p = 0.004, 0.003, < 0.001, < 0.001, respectively. Significant post-definitive fusion corrections were noticed for CTAD (0.01), CHD (0.01), nearly significant CA (0.07), non-significant CRID in EOS patients. In AIS patients, no significant corrections were noticed for CA, CTAD, CHD and but significant for CRID (0.02). At post-definitive and 2-year follow-up, CA, CRID, CHD were not significant between cohorts, but CTAD (< 0.01) was significantly higher in EOS cohort at final follow-up.

CONCLUSION

Post-definitive and 2-year follow-up shoulder balance for EOS patients was not significantly different from AIS patients.

LEVEL OF EVIDENCE

III.

摘要

研究设计

儿童脊柱研究小组的注册数据库被查询，以获取患有早发性脊柱侧凸（EOS）的患者的最终明确脊柱融合数据，这些患者的脊柱侧凸在使用生长棒或 VEPTR 治疗后，最终都接受了明确的脊柱融合。青少年特发性脊柱侧凸（AIS）患者的 Harms 研究小组的注册数据库被查询，以获取最终接受明确融合的患者的数据。

目的

评估 EOS 患者在接受确定性融合后的肩部对线情况，以及这些影像学结果与 AIS 患者接受确定性融合后的肩部对线情况有何不同。

背景

EOS 是一种具有挑战性的疾病，需要进行管理。对于该人群的脊柱手术，有许多因素都很重要。肩部平衡是患者容易看到的一个方面。最近，人们越来越关注其与患者满意度的关系。

方法

样本量：n=145（EOS（n=34）和 AIS（n=111））。从回顾性 X 光片中测量锁骨角度（CA）、喙突高度差（CHD）、锁骨倾斜角差（CTAD）和锁骨-胸廓交界差值（CRID）等肩平衡参数（SBP），并记录术前、术后和术后 2 年随访的测量值。在各个记录时间点，将 EOS 和 AIS 队列的肩平衡参数进行比较。

结果

EOS 患者在接受确定性融合前的 SBP（CA、CTAD、CRID、CHD）均值明显高于 AIS 患者，p=0.004、0.003、<0.001、<0.001，分别。EOS 患者的 CTAD（0.01）、CHD（0.01）、CA（0.07）接近显著、CRID（0.01）在术后确定性融合后有显著的纠正。AIS 患者的 CA、CTAD、CHD 无显著改善，但 CRID（0.02）有显著改善。在术后和 2 年随访时，CA、CRID、CHD 在两组之间无显著差异，但在最终随访时，EOS 组的 CTAD（<0.01）仍显著升高。