Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
J Orthop Sci. 2023 May;28(3):529-535. doi: 10.1016/j.jos.2022.01.015. Epub 2022 Mar 4.
Fulcrum-bending (FB) correction is considered to provide the best estimation of main thoracic (MT) curve flexibility and postoperative correction in surgical treatment for adolescent idiopathic scoliosis (AIS). However, few studies evaluated the usefulness of FB radiographs for proximal thoracic (PT) curve. We aimed to perform flexibility assessments using both active side-bending (SB) and FB radiographs and evaluate surgical outcomes after posterior spinal fusion (PSF) for Lenke type 2 AIS.
This study included 38 consecutive patients with Lenke type 2 AIS who underwent PSF using a pedicle screw construct with a minimum 2-year follow-up. Radiographic parameters, including correction rate, SB and FB flexibility, and FB correction index (FBCI: [correction rate/FB flexibility] × 100), were evaluated preoperatively, immediately after surgery, and at the 2-year follow-up. The clinical outcomes were preoperatively evaluated using the Scoliosis Research Outcomes Instrument-22 and at the follow-up.
All scoliosis curves significantly improved and shoulder balance shifted toward left shoulder elevation (all comparisons, p < 0.0001). There were significant differences between the SB and FB corrections in the PT and MT curves (p < 0.0001). The magnitudes of the discrepancies between the SB and FB corrections in the PT and MT curves were 11.2° ± 5.2° and 11.6° ± 7.2°, respectively. FB correction did not differ from postoperative Cobb angles correction immediately after surgery or at the 2-year follow-up; the mean FBCIs in the PT and MT curves were 98.8% and 105.5%, respectively. The self-image domain SRS-22 scores had significantly increased at the 2-year follow-up (p < 0.0001).
There were significant differences between the SB and FB corrections, and FB correction tended to approximate the postoperative curve correction (FBCI = 100%) for PT and MT curves in patients with Lenke type 2 AIS. FB flexibility is more reliable than SB flexibility in evaluating actual curve flexibility even for the PT curve.
在青少年特发性脊柱侧凸（AIS）的手术治疗中，折轴弯曲（FB）矫正是一种被认为可以提供最佳主胸（MT）曲线柔韧性和术后矫正的方法。然而，很少有研究评估 FB 影像学在近胸（PT）曲线上的有用性。我们旨在使用主动侧弯曲（SB）和 FB 影像学进行柔韧性评估，并评估后路脊柱融合（PSF）治疗 Lenke 2 型 AIS 的手术结果。
本研究纳入了 38 例连续接受 Lenke 2 型 AIS 后路椎弓根螺钉固定融合术的患者，随访时间至少 2 年。评估了术前、术后即刻和 2 年随访时的影像学参数，包括矫正率、SB 和 FB 柔韧性以及 FB 矫正指数（FBCI：[矫正率/FB 柔韧性]×100）。术前使用 SRS-22 量表评估临床结果，并在随访时进行评估。
所有脊柱侧凸曲线均显著改善，双肩平衡向左侧肩高移位（所有比较，p<0.0001）。PT 和 MT 曲线上的 SB 和 FB 矫正之间存在显著差异（p<0.0001）。PT 和 MT 曲线上 SB 和 FB 矫正之间的差异大小分别为 11.2°±5.2°和 11.6°±7.2°。FB 矫正与术后 Cobb 角矫正即刻或 2 年随访时无差异；PT 和 MT 曲线上的平均 FBCI 分别为 98.8%和 105.5%。2 年随访时自我形象领域 SRS-22 评分显著增加（p<0.0001）。
PT 和 MT 曲线上 SB 和 FB 矫正之间存在显著差异，并且 FB 矫正倾向于接近 Lenke 2 型 AIS 患者的术后曲线矫正（FBCI=100%）。即使对于 PT 曲线，FB 柔韧性在评估实际曲线柔韧性方面也比 SB 柔韧性更可靠。
