术前支具治疗对女性青少年特发性脊柱侧凸患者手术矫形效果的影响

目的:分析术前支具治疗对女性青少年特发性脊柱侧凸(AIS)患者手术矫形效果的影响。方法 :筛选2001年7月~2009年12月在我院接受单一后路矫形内固定手术治疗的女性青少年特发性主胸弯脊柱侧凸患者70例,其中术前接受支具治疗组(A组)26例;未接受支具治疗组(B组)44例。两组发现畸形年龄、术时年龄、术前主胸弯冠状面Cobb角、凸侧Bending像Cobb角、侧凸柔韧性、手术融合椎体数比较均无统计学差异(P>0.05),A、B组随访时间超过1年者分别为23例和34例,随访时间分别为12~101个月(平均37.7个月)、12~87个月(平均28.7个月),两组比较无统计学差异(P>0.05)。比较两组患者的手术矫形效果。结果:A组与B组患者术前主胸弯冠状面Cobb角分别为52.8°±8.3°和54.0°±10.7°,术后分别矫正到12.3°±7.3°和11.5°±8.1°,术后较术前均明显改善(P<0.01),主胸弯矫形率分别为(77.0±12.6)%和(79.3±11.9)%,两组比较无统计学差异(P>0.05);末次随访时主胸弯冠状面Cobb角分别为16.7°±8.4°和15.4°±7.2°,两组比较无统计学差异(P>0.05),主胸弯矫形率分别为(68.8±14.5)%和(70.5±13.0)%,两组比较无统计学差异(P>0.05)。A、B组患者术前主胸弯顶椎偏距分别为41.4±14.3mm和36.8±13.7mm,两组比较无统计学差异(P>0.05),术后分别被矫正到10.4±5.4mm和7.2±5.6mm,B组优于A组(P<0.05);末次随访时分别为14.4±11.3mm和12.1±8.5mm,两组比较无统计学差异(P>0.05)。A、B组患者术前、术后、末次随访时冠状面失平衡的发生比例分别为15.4%(4/26)和9.1%(4/44),15.4%(4/26)和15.9%(7/44),4.3%(1/23)和8.8%(3/34),两组比较均无统计学差异(P>0.05)。A、B组患者术前主胸弯矢状面Cobb角分别为12.9°±11.1°和18.7°±11.3°,A组胸后凸更小(P<0.05),术后主胸弯矢状面Cobb角分别被矫正到18.0°±6.3°和22.3°±7.8°,矫正度分别为5.0°±9.8°和3.6°±12.6°,两组矫正度比较无统计学差异(P>0.05);末次随访时A、B组患者主胸弯矢状面Cobb角分别为20.0°±6.7°和22.4°±7.7°,两组比较无统计学差异(P>0.05)。结论:术前支具治疗对女性青少年特发性主胸弯脊柱侧凸患者手术矫形效果未产生明显影响。

Effect of preoperative brace treatment on the surgical correction results in female adolescent idiopathic scoliosis

Objectives: To analyze the effect of preoperative brace treatment on the surgical correction results in female adolescent idiopathic scoliosis(AIS).Methods: From July 2001 to December 2009,70 female patients with major thoracic(MT) curves and under going posterior corrective surgery in our hospital were studied retrospectively.The patients were classified into two groups: group A: with preoperative Boston brace treat ment(n=26),and group B: with no preoperative brace treatment(n=44).There were no significant differences with respect to the malformation found age,age at operation,preoperative coronal Cobb angle of the MT curve,Cobb angle on convex bending film,the flexibility of the MT curve and the vertebra included in the fusion range between the 2 groups(P>0.05).Twenty-three patients in group A and 34 patients in group B were followed up for at least 1 year,and the average follow-up time of the 2 groups was 37.7 months(range,12 to 101 months) and 28.7 months(range,12 to 87 months),respectively(P>0.05).The differences of the radiographic correction results of the MT curve between the 2 groups were evaluated.Results: The mean preoperative coronal Cobb angles of the MT curve of the 2 groups were 52.8° ±8.3° and 54.0° ±10.7°.After surgery,they were corrected to 12.3°±7.3° and 11.5°±8.1°,with an average correction rate of(77.0±12.6)% and(79.3±11.9)%,respectively(P>0.05).At final follow-up,they were 16.7°±8.4° and 15.4°±7.2°,with similar correction rate(68.8±14.5)% vs.(70.5±13.0)%,P>0.05].The preoperative apical vertebral translation of the MT curve in 2 groups was 41.4±14.3mm and 36.8±13.7mm,respectively,without significant difference(P>0.05).After operation,they were corrected to 10.4±5.4mm and 7.2±5.6mm,and group B had a better correction(P< 0.05) than group A.At final follow-up,they were 14.4±11.3mm and 12.1±8.5mm,without significant difference(P>0.05).The decompensation occurrences of coronal trunk balance in group A and B were 15.4%(4/26) and 9.1%(4/44) preoperatively,15.4%(4/26) and 15.9%(7/44) postoperatively,and 4.3%(1/23) and 8.8%(3/34) at final follow-up,respectively,which showed no differences(P>0.05).The mean preoperative sagittal Cobb angles of the MT curve of the 2 groups were 12.9°±11.1° and 18.7°±11.3°,and group A had a less thoracic kyphosis(P<0.05) than group B.After surgery,the Cobb angles of thoracic kyphosis were corrected to 18.0°±6.3° and 22.3°±7.8°,with no significant difference(5.0°±9.8° and 3.6°±12.6°,P>0.05).At final follow-up,the sagittal Cobb angle of the MT curve was 20.0°±6.7° and 22.4°±7.7°,respectively(P>0.05).Conclusions: Preoperative brace treatment has no obvious impact on the correction results of the MT curve in female AIS patients.