Tanasansomboon Teerachat, Khandehroo Babak, Limthongkul Worawat, Yingsakmongkol Wicharn, Anand Neel
Department of Orthopedic Surgery, Samut Sakhon Hospital, Samut Sakhon, Thailand.
Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Global Spine J. 2025 May;15(4):2201-2208. doi: 10.1177/21925682241290759. Epub 2024 Oct 3.
Study DesignRetrospective study.ObjectivesTo determine prevalence and clinical importance of patients who had postoperative CM after CMIS for ASD correction.MethodsWe reviewed patients who underwent CMIS technique. Inclusion criteria were patients who were diagnosed with ASD, which is defined as having at least one of the following: coronal Cobb angle >20, SVA >50 mm, PI-LL >10, PT >20. They underwent >4 spinal levels fusion with CMIS technique and had at least 1-year follow-up. Preoperative and 1-year postoperative radiographs and clinical outcome measures (VAS, ODI, and SRS-22 scores) were used to make the comparisons.Results120 patients were included. Radiographic outcomes, including CVA, coronal Cobb angle, LSF curve, SVA, LL, and PI-LL, and clinical outcomes, were significantly improved postoperatively in each of the 3 preoperative subgroups (Bao type A, B, and C). At 1-year post-operation, 10 patients (12.4 %) of type A turned out to be CM, 4 patients (21.1%) of type B, and 8 patients (40%) of type C remained CM. Comparing coronally aligned (CA) to coronally mal-aligned patients at 1-year follow-up in each coronal subtype revealed that clinical and radiographic outcomes were comparable.ConclusionsCMIS technique significantly improves radiographic and clinical outcomes for ASD patients. Incidence rates of postoperative CM were similar to open surgery. Type C patients were at risk of postoperative CM than types A and B. However, most 1-year outcomes were not significantly different between postoperative CA and CM patients regardless of the preoperative coronal alignment characteristics except ODI scores in type A.
研究设计
回顾性研究。
目的
确定在应用CMIS进行房间隔缺损（ASD）矫正术后发生术后冠状面失平衡（CM）的患者的患病率及其临床重要性。
方法
我们回顾了接受CMIS技术治疗的患者。纳入标准为被诊断为ASD的患者，ASD定义为具有以下至少一项：冠状面Cobb角>20、矢状面垂直轴（SVA）>50mm、骨盆入射角-腰椎前凸角（PI-LL）>10、骨盆倾斜角（PT）>20。他们采用CMIS技术进行了超过4个脊柱节段的融合，并且有至少1年的随访。使用术前和术后1年的X线片以及临床结局指标（视觉模拟评分法（VAS）、腰椎功能障碍指数（ODI）和脊柱侧凸研究学会22项问卷（SRS-22）评分）进行比较。
结果
共纳入120例患者。在术前的3个亚组（鲍氏A、B和C型）中，术后的影像学结局，包括冠状面垂直轴（CVA）、冠状面Cobb角、腰椎前凸曲线、SVA、腰椎前凸（LL）和PI-LL，以及临床结局均有显著改善。术后1年时，A 型患者中有10例（12.4%）出现CM，B型患者中有4例（21.1%），C型患者中有8例（40%）仍存在CM。在每个冠状面亚型的1年随访中，将冠状面对齐（CA）的患者与冠状面未对齐的患者进行比较，结果显示临床和影像学结局具有可比性。
结论
CMIS技术显著改善了ASD患者的影像学和临床结局。术后CM的发生率与开放手术相似。C型患者比A 型和B型患者有更高的术后CM风险。然而，除了A 型患者的ODI评分外，无论术前冠状面对齐特征如何，术后CA和CM患者之间的大多数1年结局并无显著差异。
