Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospitals Cleveland Medical Center, CaseWestern Reserve University School of Medicine, Cleveland, OH.
J Pediatr Orthop. 2021 Oct 1;41(9):e706-e711. doi: 10.1097/BPO.0000000000001846.
Preoperative radiographic assessment of curve flexibility in patients with idiopathic scoliosis is important to determine Lenke classification, operative levels, and potential postoperative correction. However, no consensus exists regarding the optimal technique. We compared measurements from supine side bending (SB) and intraoperative traction radiographs under general anesthesia (TUGA) with actual postoperative correction followed for 1 year.
We identified 235 patients with idiopathic scoliosis who underwent posterior spinal fusion with pedicle screw instrumentation between 2010 and 2018 who had preoperative and postoperative radiographs including standing posterior-anterior (PA) and lateral radiographs, preoperative SB radiographs, and TUGA radiographs. Curves were categorized into proximal thoracic, main thoracic/thoracolumbar (MT), and distal thoracolumbar/lumbar (TL/L) curves. Flexibility was calculated from SB and TUGA radiographs. Correction rates were calculated from 1 month and 1 year radiographs postoperatively. Bending radiographs that correlated significantly with postoperative correction with P<0.10 were eligible for inclusion. Preoperative demographics, etiology, deformity details, and surgical details were included in the multivariate models.
On univariate analysis, TUGA radiographs correlated with postoperative correction at 1 month and 1 year on MT curves (r=0.214, P=0.001; r=0.209, P=0.001) and TL/L curves (r=0.280, P<0.001; r=0.181, P=0.006). Supine SB radiographs did not correlate with postoperative correction on either MT or T/TL curves. On multivariate analysis, major curve TUGA radiographs were independently associated with postoperative MT curve correction at 1 month (beta: 0.158, 95% confidence interval: 0.035-0.280, P=0.012) and 1 year (beta: 0.195, 95% confidence interval: 0.049-0.340, P=0.009). MT curve SB radiographs were not associated with postoperative major curve correction at 1 month (P=0.088).
TUGA radiographs independently correlated with postoperative main thoracic and distal thoracolumbar/lumbar curve correction at 1 month and 1 year postoperatively. SB radiographs independently correlated only with TL/L curve correction at 1 year postoperatively. However, this correlation was not as strong as TUGA correction (beta of 0.280 vs. beta of 0.092). TUGA radiographs appear superior to SB radiographs at predicting curve correction after surgery.
Level III.
评估特发性脊柱侧凸患者术前曲线柔韧性对于确定 Lenke 分类、手术水平和潜在术后矫正非常重要。然而，目前尚无关于最佳技术的共识。我们比较了仰卧位侧弯曲（SB）和全身麻醉下术中牵引（TUGA）测量值与 1 年后实际术后矫正值。
我们确定了 2010 年至 2018 年间接受后路脊柱融合加椎弓根螺钉内固定术的 235 例特发性脊柱侧凸患者，这些患者均有术前和术后站立前后位（PA）和侧位片、术前 SB 片和 TUGA 片。曲线分为胸上段、胸主段/胸腰椎（MT）和胸腰下段/腰椎（TL/L）。从 SB 和 TUGA 片计算柔韧性。术后 1 个月和 1 年的矫正率从术后 1 个月和 1 年的 X 线片计算。与术后矫正相关的弯曲片 P<0.10 者入选。多元模型中包括术前人口统计学、病因、畸形细节和手术细节。
单因素分析显示，TUGA 片与 MT 曲线（r=0.214，P=0.001；r=0.209，P=0.001）和 TL/L 曲线（r=0.280，P<0.001；r=0.181，P=0.006）的术后 1 个月和 1 年矫正值显著相关。仰卧 SB 片与 MT 或 T/TL 曲线的术后矫正均无相关性。多因素分析显示，主要曲线 TUGA 片与术后 1 个月（β：0.158，95%置信区间：0.035-0.280，P=0.012）和 1 年（β：0.195，95%置信区间：0.049-0.340，P=0.009）MT 曲线矫正独立相关。MT 曲线 SB 片与术后 1 个月的主要曲线矫正无相关性（P=0.088）。
TUGA 片独立于术后主要胸段和胸腰下段/腰椎段矫正，与术后 1 个月和 1 年的矫正相关。SB 片仅与术后 1 年的 TL/L 曲线矫正相关，但与 TUGA 矫正的相关性不如 TUGA 矫正（β为 0.280，β为 0.092）。TUGA 片在预测术后曲线矫正方面优于 SB 片。
III 级。
