McCance S E, Denis F, Lonstein J E, Winter R B
Dept. of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York.
Spine (Phila Pa 1976). 1998 Oct 1;23(19):2063-73. doi: 10.1097/00007632-199810010-00005.
A retrospective study by an independent observer of a consecutive series of 67 cases of adolescent idiopathic scoliosis presenting with a King II curve pattern.
To demonstrate the validity of a selective thoracic fusion as a treatment of King II curves with special attention to immediate postoperative and long-term trunk balance in the coronal and sagittal planes.
The literature has been fairly controversial in terms of the recommended treatment of King II curve patterns in adolescent idiopathic scoliosis. The main confusion appears to be whether the thoracic curve alone or both curves should be instrumented and fused.
Sixty-seven patients were identified as having had a selective posterior thoracic spine fusion with instrumentation between 1961 and 1994. None of these cases had a fusion of the lumbar spine. Preoperative radiographs were analyzed for determination of the appropriate fusion level using the criteria of the stable and neutral vertebra. Follow-up radiographs were evaluated for balance in the coronal and sagittal planes using the central sacral line on posteroanterior radiograph and the C7 sacral promontory line on lateral film.
At 2-year or greater follow-up, the unfused lumbar curve remained equal to or less than the corrected thoracic curve in 63 patients (94%). No patient required extension of fusion. Frontal plane balance analysis showed that 47 of the 67 patients had the T1 plumb line within 2 cm of the midline for an average decompensation of 8.7 mm. In no patient was the loss of balance greater than 3.8 cm. Sagittal plane balance analysis showed that only one patient had inferior junctional kyphosis greater than 10 degrees. This did not require extension of fusion. There were no cases of superior junctional kyphosis.
The concept of selective thoracic fusion in the King II curve pattern appears to be valid. These findings suggest that arthrodesis of the lumbar spine can be avoided when this pattern is properly diagnosed and appropriately treated. Proper identification of the stable and neutral vertebra and of the appropriate level of fusion are important to achieve good postoperative balance. Successful preservation of lumbar motion segments is important to long-term satisfactory outcome in adolescent idiopathic scoliosis.
由一名独立观察者对连续67例呈现King II型曲线模式的青少年特发性脊柱侧凸病例进行回顾性研究。
证明选择性胸椎融合术作为治疗King II型曲线的有效性，特别关注术后即刻和长期冠状面和矢状面的躯干平衡。
关于青少年特发性脊柱侧凸中King II型曲线模式的推荐治疗方法，文献中存在相当大的争议。主要的困惑似乎在于仅对胸椎曲线还是对两条曲线都进行器械固定和融合。
确定67例患者在1961年至1994年间接受了选择性后路胸椎融合术并使用了器械。这些病例均未进行腰椎融合。术前X线片根据稳定椎和中立椎的标准进行分析以确定合适的融合节段。随访X线片通过后前位片上的中央骶骨线和侧位片上的C7骶骨岬线评估冠状面和矢状面的平衡。
在2年或更长时间的随访中，63例患者（94%）未融合的腰椎曲线保持等于或小于矫正后的胸椎曲线。没有患者需要延长融合范围。冠状面平衡分析显示，67例患者中有47例T1铅垂线位于中线2厘米范围内，平均失代偿为8.7毫米。没有患者的平衡丧失大于3.8厘米。矢状面平衡分析显示，只有1例患者的下终末交界性后凸大于10度。这不需要延长融合范围。没有上终末交界性后凸的病例。
King II型曲线模式下选择性胸椎融合的概念似乎是有效的。这些发现表明，当正确诊断并适当治疗这种模式时，可以避免腰椎融合。正确识别稳定椎和中立椎以及合适的融合节段对于实现良好的术后平衡很重要。成功保留腰椎运动节段对于青少年特发性脊柱侧凸的长期满意结果很重要。
