Vital Luísa, Nunes Bernardo, Santos Sara Almeida, Veludo Vitorino, Serdoura Francisco, Pinho André
Departamento de Ortopedia e Traumatologia, Centro Hospitalar Universitário de São João, Porto, Portugal.
Centro Hospitalar Universitário de São João, Porto, Portugal.
Rev Bras Ortop (Sao Paulo). 2021 Aug;56(4):446-452. doi: 10.1055/s-0041-1724078. Epub 2021 Aug 30.
To evaluate and correlate the pelvic parameters, the sagittal balance (SB), and the functional outcome of the patients submitted to surgical treatment for Scheuermann hyperkyphosis (SK). Patients submitted to surgery between January 2005 and December 2016 were included. The following radiographic measurements were obtained: thoracic kyphosis (TK); lumbar lordosis (LL); SB; pelvic incidence (PI); pelvic tilt (PT); and sacral slope (SS). Complications during the follow-up period were recorded. A total of 19 patients were included (16 males): the mean preoperative kyphosis was of 83°, and the postoperative kyphosis was of 57°. The mean preoperative lumbar lordosis was of 66°, with a postoperative spontaneous correction of 47°. Regarding the preoperative pelvic parameters, the average PI, PT and SS were of 48°,10° and 39° respectively. In the postoperative period, these values were of 50°, 16° and 35° respectively. The preoperative SB was neutral, and it was maintained after the surgical correction. Concerning complications during the follow-up period, three junctional kyphosis were observed-two requiring revision surgery, one nonunion, and one dehiscence of the surgical wound. Regarding the functional results, the average score on the Scoliosis Research Society-22 (SRS-22) patient questionnaire was of 4.04, and we verified that the SB obtained in the postoperative period had no influence on the functional outcome ( = 0.125) nor on the postoperative LL ( = 0.851). We verified a spontaneous improvement in the lumbar hyperlordosis at levels not included in the fusion after correction of the TK. Although the postoperative functional results were globally high, we did not find any statistically significant relationship with TK nor LLs. high PI is associated with a greater rate of complications regarding the proximal junctional kyphosis (PJK), and these pelvic parameters should be considered at the time of the SK surgical treatment.
为评估并关联接受休门氏后凸畸形（SK）手术治疗患者的骨盆参数、矢状面平衡（SB）及功能结果。纳入2005年1月至2016年12月期间接受手术的患者。进行以下影像学测量：胸椎后凸（TK）、腰椎前凸（LL）、SB、骨盆倾斜度（PI）、骨盆倾斜（PT）及骶骨坡度（SS）。记录随访期间的并发症。共纳入19例患者（16例男性）：术前平均后凸为83°，术后为57°。术前平均腰椎前凸为66°，术后自发矫正至47°。术前骨盆参数方面，平均PI、PT和SS分别为48°、10°和39°。术后这些值分别为50°、16°和35°。术前SB为中性，手术矫正后得以维持。关于随访期间的并发症，观察到3例交界性后凸——2例需要翻修手术，1例骨不连，1例手术切口裂开。关于功能结果，脊柱侧弯研究学会-22（SRS-22）患者问卷的平均得分为4.04，且我们证实术后获得的SB对功能结果（P = 0.125）及术后LL（P = 0.851）均无影响。我们证实在TK矫正后，未融合节段的腰椎前凸有自发改善。尽管术后功能结果总体较高，但我们未发现与TK或LL有任何统计学上的显著关系。高PI与近端交界性后凸（PJK）的并发症发生率较高相关，在SK手术治疗时应考虑这些骨盆参数。
