全节段椎弓根螺钉后路选择性融合胸弯或腰弯后代偿弯的自发性矫形比较

目的 比较后路选择性融合胸弯或胸腰弯/腰弯矫正青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)后代偿弯的自发性矫形.方法 回顾性分析随访2年以上的双弯型AIS患者共41例(男6例,女35例),手术时平均年龄为13.8(11～16)岁,随访时间平均29(24～36)个月.北京协和医学院(Peking Union Medical College Hospital,PUMC)分型Ⅱb1型13例,Ⅱc1型5例,Ⅱc3型7例,Ⅱd1型16例.分为选择性胸弯融合(STF)组21例和选择性胸腰弯/腰弯融合组(SLF)20例.术前、术后和随访2年时摄站立位全脊柱正侧位和术前仰卧位左右弯曲像.结果 STF组和SLF组融合节段分别为(9.1±0.9)个和(5.5±0.7)个;术前和术后随访2年以上躯干偏移(TS)在STF组分别为(14.8±7.8)mm和(11.4±5.9)mm(P=0.048);SLF组为(24.7±7.3)mm和(13.2±4.9)am(P＜0.001);STF组代偿性腰弯由37.7°±6.8°自发矫形为15.1°±8.4°(P=0.001);SLF组代偿性胸弯由27.4°±6.7°自发矫形为14.9°±5.0°(P＜0.001).术前和术后2年在STF组中胸后凸由18.0°±6.8°降至13.5°±7.6°(P＜0.01),腰前凸由37.9°±8.4°增至43.8°±6.8°(P＜0.05);SLF组中胸后凸由12.8°±7.8°增至28.4°±10.8°(P＜0.001),腰前凸由33.4°±8.8°增至39.6°±6.9°(P＜0.05).两组术前与术后即刻、术后2年腰弯Lenke分型差异有统计学意义(P＜0.001).结论 后路全节段椎弓根螺钉系统选择性融合胸弯或胸腰弯/腰弯矫正AIS代偿弯在冠状面、矢状面上自发性矫形程度不同,腰弯Lenke分型在两组中变化明显.

Comparison of spontaneous curve correction after selective fusions of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs

Objective To compare spontaneous curve correction on the coronal and sagittal plane in adolescent idiopathic scoliosis(AIS)underwent selective posterior thoracic or lumbar fusion.Methods Forty-one patients with AIS receiving selective posterior correction and fusion with pedicle screw-only constructs over 2 years follow-up were reviewed.There were 6 males and 35 females with an average age of 13.8 years.The curves included 13 cases of PUMC Ⅱb1,5 of Ⅱc1,7 of Ⅱc3 and 16 of Ⅱd1.All patients were divided in-to two groups: selective thoracic fusion group(STF,n=21)and selective lumbar fusion group(SLF,n=20).Results The average fused vertebrae was 9.1±0.9 segments in STF group and 5.5±0.7 in SLF group.The trunk shift(TF)decreased from(14.8±7.8)mm before surgery to(11.4±5.9)mm at final follow-up(P=0.048)in STF group and from(24.7±7.3)mm to(13.2±4.9)mm in SLF group.The spontaneous lumbar curve de-creased from 37.7°±6.8° to 15.1°±8.4°(P=0.001)in STF group.The spontaneous thoracic curve decreased from 27.4°±6.7° to 14.9°±5.0° in SLF group(correction rate: 47.34%,P＜0.001).The thoracic kyphosis was corrected from 18.0°±6.8° before surgery to 13.5°±7.6° at final follow-up(P＜0.01)and lumbar lordosis from37.9°±8.4° to 43.8°±6.8°(P＜0.05)in STF group.The thoracic kyphosis was corrected from 12.8°±7.8° before surgery to 28.4°±10.8° at final follow-up(P＜0.01)and lumbar lordosis from 33.4°±8.8° to 39.6°±6.9°(P＜0.05)in SLF group.Lenke classification was also significantly different before surgery and at final follow-up(P＜0.001).Conclusion The different spontaneous curve correction on the coronal and sagittal plane in both groups was noted,and the lumbar curve classification is also corrected.