Acta Orthop Belg. 2022 Sep;88(3):457-466. doi: 10.52628/88.3.9466.
Postoperative shoulder imbalance (PSI) is a common complication following adolescent idiopathic scolio- sis (AIS) surgery. There is little data available in literature on prediction of PSI. Prospectively collected data of AIS with thoracic curve (Lenke 2), operated in 2014-2018 at a single scoliosis-center, were analyzed retrospectively using X-rays of whole spine and traction films (TA): age, Cobb-angle of proximal (PC), major thoracic (MC) and lumbar curve (LC), shoulder height [mm], clavicle angle [°], T1-tilt [°], plumb line [mm]. Results as mean ± standard deviation. Change over time (postOP- FU) compared using t-test (≥=0.05). Correlation of preOP parameters and curve correction with PSI (|≥|15mm) was analyzed by correlation (Pearson)- and regression-classification-analysis. 32 AIS, average age of 14±1.3 yrs. FU 16 months (84%). Curve correction was 52.5% (PC), 70.1% (MC), 69.9% (LC), significant change in FU for PC (-2.4°, p>0.05), not for MC, LC (p=0.2, p=0.6). Shoulder height was negative if right- side up: 2.9±15.1mm (preOP), 5.5±15.0 mm (TA), 17.9±14.9mm (postOP), 17.4±8.4mm (FU). 28% had preOP shoulder imbalance, 69% postOP and 44% FU had PSI. Shoulder height on TA correlated to change preOP to FU (r=0.62) and preOP shoulder height (r=-0.85), clavicle angle had strong correlation (r=- 0.81). Regression-classification-analysis: correction of MC>62.4%, 81.5% of cases had PSI; with correction of MC>64.9% and LC>93.2%, 51.9% of cases had PSI. PSI is a common in Lenke2 AIS. In preOP planning TA, shoulder position and clavicle angle should be considered to prevent PSI. Correction of MC should be moderate, overcorrection of the LC avoided.
术后肩部失衡（PSI）是青少年特发性脊柱侧凸（AIS）手术后的常见并发症。文献中关于PSI 预测的数据很少。本研究回顾性分析了 2014 年至 2018 年在一家脊柱侧弯中心接受手术的胸弯（Lenke 2）AIS 患者的前瞻性收集数据，使用全脊柱 X 线片和牵引片（TA）进行分析：年龄、近端 Cobb 角（PC）、主要胸椎（MC）和腰椎曲线（LC）、肩高[mm]、锁骨角[°]、T1 倾斜[°]、铅垂线[mm]。结果表示为平均值±标准差。使用 t 检验（≥0.05）比较术后（postOP-FU）的时间变化。通过相关性（Pearson）和回归分类分析，分析术前参数和曲线矫正与 PSI（绝对值≥15mm）的相关性。32 例 AIS，平均年龄 14±1.3 岁。FU 为 16 个月（84%）。PC 的曲线矫正为 52.5%，MC 为 70.1%，LC 为 69.9%，在 FU 时 PC 有显著变化（-2.4°，p＞0.05），MC 和 LC 没有变化（p=0.2，p=0.6）。如果右侧肩部升高，则肩高为负值：2.9±15.1mm（术前）、5.5±15.0mm（TA）、17.9±14.9mm（术后）、17.4±8.4mm（FU）。28%的患者术前存在肩部不平衡，69%的患者术后和 44%的患者 FU 存在 PSI。TA 上的肩高与术前至 FU 的变化相关（r=0.62）和术前肩高（r=-0.85），锁骨角有很强的相关性（r=-0.81）。回归分类分析：MC 矫正>62.4%，81.5%的病例有 PSI；MC 矫正>64.9%和 LC 矫正>93.2%，51.9%的病例有 PSI。PSI 在 Lenke2 AIS 中很常见。在术前计划中，TA、肩部位置和锁骨角度应考虑在内，以预防 PSI。MC 的矫正应适度，避免 LC 的过度矫正。
