加速康复外科方案在青少年特发性脊柱侧凸围手术期的应用实践

目的:探讨加速康复外科(enhanced recovery after surgery,ERAS)方案在青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)矫形围手术期临床应用的效果。方法:回顾性分析2010年9月～2016年8月在我院骨科接受矫形手术的AIS患者(未进行三柱截骨)91例,其中应用常规围手术期方案(对照组)51例;围手术期应用ERAS方案(ERAS组)40例,观察并记录两组患者年龄、性别、体质指数(body mass index,BMI)、术前血红蛋白、麻醉风险分级、侧凸分型(Lenke)、术前冠状位Cobb角、手术时间、融合节段、椎弓根螺钉置入数量、冠状面矫形率、出血量、输同种异体血比例、术后血红蛋白、术后疼痛视觉模拟评分(visual analogue scale,VAS)、引流量、引流管移除时间、术后住院日、患者满意度、术后并发症。组间数据采用独立样本t检验比较连续变量,采用卡方检验或Fisher′s精确检验比较分类变量。结果:两组患者年龄、性别、BMI、术前血红蛋白、麻醉风险分级、侧凸分型与术前冠状位Cobb角无统计学差...     

King Ⅱ型特发性脊柱侧凸的手术治疗

目的：探讨King Ⅱ型特发性脊柱侧凸患者三维矫形融合节段的选择。方法：1997年7月～2002年6月手术矫形治疗King Ⅱ型特发性脊柱侧凸患者79例，平均年龄14．3岁，其中King Ⅱ A型28例，均行选择性胸椎融合，平均融合椎体8．5个；King ⅡB型51例，均固定融合胸椎与腰椎，平均融合椎体11．8个。结果：术后平均随访35个月(12～57个月)，King ⅡA型胸弯矫正率为56％，King ⅡB型的胸弯矫正率为67％，腰弯矫正率为60％。共有5例躯干失平衡并发症，其余患者均获得较好的躯干平衡和矫形效果。结论：KingII型特发性脊柱侧凸进行选择性胸椎融合是可行的，但应慎重。     

Enhanced recovery after surgery care to reduce surgical site wound infection and postoperative complications for patients undergoing liver surgery

This study comprehensively assessed the effect of enhanced recovery after surgery (ERAS) on wound infection and postoperative complications in patients undergoing liver surgery. The PubMed, EMBASE, MEDLINE, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang electronic databases were searched to collect published studies on the use of ERAS in liver surgery until December 2022. Literature selection was performed independently by two investigators according to the inclusion and exclusion criteria, and quality evaluation and data extraction were performed. RevMan 5.4 software was used in this study. Compared with the control group, the ERAS group showed a significantly lower incidence of postoperative wound infection (odds ratio [OR]: 0.59, 95% confidence interval [CI]: 0.41–0.84, P = .004) and overall postoperative complication rate (OR: 0.43, 95% CI: 0.33–0.57, P < .001) and significantly shorter postoperative hospital stay (mean difference: −2.30, 95% CI: −2.92 to −1.68, P < .001). Therefore, ERAS was safe and feasible when applied to liver resection, reducing the incidence of wound infection and total postoperative complications, and shortening the length of hospital stay. However, further studies are required to investigate the impact of ERAS protocols on clinical outcomes.     

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。     

Lenke 5型青少年特发性脊柱侧凸患者后路矫形术后颈椎矢状位曲度的改变

目的 :分析Lenke 5型青少年特发性脊柱侧凸(AIS)患者颈椎矢状位曲度(CSA)在后路矫形术后改变的特点。方法:回顾性分析2011年7月～2017年7月解放军总医院脊柱外科收治的43例Lenke 5型AIS患者的临床资料。在术前、术后及末次随访时的X线片上测量颈椎前凸角(CL)、胸椎后凸角(TK)、胸腰段后凸角(TLK)、腰椎前凸角(LL)、融合节段内腰椎前凸角(LIF)、C7矢状位垂直距离(SVA)。同时统计患者的基本资料,包括性别、年龄、Risser征、随访时间、融合节段椎体数目(NVF)及术前胸腰段/腰弯(TL/L Curve,TL/L C)。依据患者术前CSA分为颈椎前凸组(L组,术前CL0°)、颈椎后凸组(K组,术前CL≥0°);依据患者末次随访时CSA较术前的改变分为颈椎前凸增加组(I组)与颈椎前凸减少组(D组)。使用t检验分析L组与K组、I组与D组对应参数的差异性,使用LSD-t检验分析各组内术前、术后、末次随访时参数的差异。使用Pearson相关性检验分析CL与I组和D组各参数的相关性。检验水准为双侧α=0.05。结果:43例患者中男10例,女33例;年龄15.90±4.98岁,随访时间22.84±14.10个月。L组15例,K组17例;I组26例,D组17例。L组与K组、I组与D组的基本资料无显著性差异。所有患者末次随访时TK较术前增加(P=0.000);术后TLK与术前比较有显著性差异(P=0.000);CL在术前、术后及末次随访时无统计学差异。L组与K组术前CL(P=0.000)、LIF(P=0.029)、SVA(P=0.003)差异有统计学意义(P0.05)。K组末次随访时CL较术前改善(P=0.025),TK较术前增加(P=0.000);术后TLK较术前减小(P=0.002)并维持至末次随访(P=0.002)。I组与D组术前LL(P=0.043)、CL(P=0.009)有显著性差异(P0.05)。I组末次随访时CL较术前改善(P=0.008),TK较术前(P=0.000)及术后(P=0.001)增加;术后TLK较术前减小(P=0.005)并维持到末次随访时(P=0.006)。D组术后LL较术前增加(P=0.011)并维持到末次随访(P=0.001)。I组术前CL与TK、SVA有相关性;D组CL术前与LL、SVA,术后与TLK、SVA,末次随访时与TLK有相关性。结论:术前颈椎后凸的患者较颈椎前凸的患者在术后CSA的改善更为明显;随访中TK增加、术后TLK改善可能有助于CSA的改善;术后只有LL增加而无TK、TLK的改变则可能不会引起CSA改善。     

Enhanced recovery after surgery programs hasten recovery after colorectal resections

Colorectal resection was traditionally associated with significant morbidity and prolonged stay in hospital.Laparoscopic colorectal resection was first described in 1991 as a minimally invasive form of colorectal surgery.It was later on assessed by multiple randomized controlled trials and meta-analysis and was found to be associated with a faster recovery,lower complication rates and a shorter stay in hospital compared with open resection.To assess the effect of enhanced recovery after surgery (ERAS) program on postoperative length of stay after elective colorectal resections,a literature review was conducted,supplemented by the results of 111 ERAS colorectal resections at regional NWS Hospital using a protocol based on the Fast Track approach described by Kehlet in 1999.ERAS has been shown to improve postoperative recovery,reduce length of stay and enhance early return to normal function when compared with traditional colorectal surgical protocols.The role of laparoscopic surgery in colorectal resections within a fast-track (ERAS) program is controversial.The current evidence suggests that within such a program,there is no difference between laparoscopic and open colorectal surgery in terms of postoperative recovery rates or length of hospital stay.     

Anterior surgery for adolescent idiopathic scoliosis

Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50–60 %). Thoracic hypokyphosis and rib hump correction with open anterior rather than posterior instrumentation appear to be the better approaches, although the latter is somewhat controversial with current posterior vertebral column derotation devices. In patients with Risser grade 0, hyperkyphosis and adding-on may occur with anterior thoracic spine instrumentation. Anterior thoracoscopic instrumentation provides a similar correction (65 %) with good cosmetic outcomes, but it is associated with a rather high risk of instrumentation (pull-out, pseudoarthrosis) and pulmonary complications. Approximately 80 % of patients with adolescent idiopathic scoliosis (AIS) curves of >70° have restrictive lung disease or smaller than normal lung volumes. AIS patients undergoing anterior thoracotomy or anteroposterior surgery will demonstrate a significant decrease in percentage of predicted lung volumes during follow-up. The thoracoabdominal approach and thoracoscopic approach without thoracoplasty do not produce similar changes in detrimental lung volume. In patients with severe AIS (>90°), posterior-only surgery with TPS provides similar radiographic correction of the deformity (44 %) with better pulmonary function outcomes than anteroposterior surgery. Vascular spinal cord malfunction after segmental vessel ligation during anterior scoliosis surgery has been reported. Based on the current literature, the main indication for open anterior scoliosis instrumentation is Lenke 5C thoracolumbar or lumbar AIS curve with anterior instrumentation typically between T11 and L3.     

Functional recovery after discharge in enhanced recovery video-assisted thoracoscopic lobectomy: a pilot prospective cohort study

Little is known about functional recovery following patient discharge in an established enhanced recovery programme after video-assisted thoracoscopic lobectomy. We conducted a single-centre pilot prospective observational cohort study. We hypothesised that patients achieved early functional recovery after discharge. A total of 32 patients aged ≥ 18 years were enrolled. A digital device was used for objective activity measurements, and patient-reported outcomes were collected as subjective measurements. Primary outcomes were the difference in physical activity; sleep duration; pain; fatigue; and average quality of life scores between pre-operative baseline and 7 days following discharge. The secondary outcome was the reason for reduced daily activity during the first 7 days after discharge. Median (IQR [range]) length of stay was 3 (2–5 [1–13]) days. Up to post-discharge day 7, total, lower intensity and moderate-to-vigorous activities were lower than pre-operative activity (p < 0.001; p = 0.005 and p = 0.027, respectively). Numerical rating scale (0–10) pain scores increased postoperatively at rest (mean difference 1.2, p < 0.001) and during walking (mean difference 1.4, p < 0.001). Fatigue assessed by the Christensen Fatigue Scale (1–10) was also increased postoperatively (mean difference 1.7, p = 0.001). There was a reduction in quality of life scores, while sedentary activity and sleep duration were unchanged postoperatively. Dominant reasons for not recovering daily activity included fatigue in 43% and pain in 33% of patients. Despite compliance with an enhanced recovery programme with a median length of hospital stay of 3 days after video-assisted thoracoscopic lobectomy, functional recovery was not achieved within 7 days after hospital discharge. Reduction in postoperative pain and fatigue are important factors to enhance functional recovery.     

后路矫形手术对青少年特发性脊柱侧凸患者脊柱高度的影响

要】 目的：评估后路矫形手术对青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）患者脊柱高度的矫正程度及其影响因素。方法：2010年1月~2011年6月接受后路矫形内固定术的AIS患者277例,单弯（single curve,SC）173例,双弯（double curve,DC）104例,站立位主弯Cobb角平均53.63°±15.38°（40°~140°）,仰卧位主弯Cobb角43.87°±15.01°（20°~124°）。脊柱高度（spinal height,SH）定义为仰卧位全脊柱正位X线片上T1椎体上终板中点至S1椎体上终板中点之间的垂直距离。测量术前、术后SH,ΔSH为手术矫正SH值。评估不同Cobb角侧凸患者的ΔSH,并采用偏相关分析评估脊柱侧凸术前Cobb角、Cobb角矫正值、Cobb角矫正率、术前SH及术后SH与ΔSH的相关性。结果：SC组仰卧位Cobb角术后矫正至15.69°±9.21°（4°~79°）,DC组仰卧位主弯Cobb角术后矫正至19.50°±13.07°（3°~95°）,矫正率分别为69.7%和65.5%。SC组和DC组术前SH分别为41.29±2.96cm和39.97±3.26cm,术后SH分别为43.77±2.71cm和42.86±3.04cm。SC组术前仰卧位Cobb角分别为≤30°、31°~40°、41°~50°、51°~60°、61°~70°、71°~80°、>80°时,ΔSH分别为1.97±0.79cm、2.14±0.63cm、2.52±0.65cm、2.77±0.51cm、3.92±0.61cm、4.33±0.22cm、4.85±0.22cm;而在DC组中,ΔSH分别为2.37±0.60cm、2.35±0.69cm、2.56±0.53cm、3.27±0.40cm、3.79±0.94cm、3.89±1.11cm、5.46±0.91cm。ΔSH与术前Cobb角[SC：r=0.702,P<0.001;DC（主弯+次发弯）：r=0.718,P<0.001]、Cobb角矫正值[SC：r=0.659,P<0.001;DC（主弯+次发弯）：r=0.698,P<0.001]和术后SH[SC：r=0.182,P=0.017;DC（主弯+次发弯）：r=0.213,P=0.033]呈显著相关性,但与Cobb角矫正率[SC：r=0.083,P>0.05;DC（主弯+次发弯）：r=0.039,P>0.05]和术前SH[SC：r=-0.082,P>0.05;DC（主弯+次发弯）：r=-0.047,P>0.05]无明显相关性。结论：后路矫形手术可显著改善AIS患者的SH,术前Cobb角和Cobb角矫正值是影响SH矫正程度的主要因素,术后SH是次要影响因素,而Cobb角矫正率则影响不大。     

三维矫形手术治疗青少年特发性脊柱侧凸

目的：回顾分析三维矫形内固定手术治疗青少年特发性脊柱侧凸（AIS）的临床效果。探讨手术相关融合区的选择问题。方法：2001年-2006年在我院行三维矫形内固定手术的AIS患者78例。男27例，女51例，年龄10～18岁，平均15．6岁，其中LenkeI型38例，Lenke Ⅱ型6例，LenkeⅢ型11例．LenkeⅣ型1例，LenkeV型14例，LenkeVI型8例。术前冠状面Cobb角平均560，顶椎偏距平均5．9cm。躯干偏移距离平均2．8cm。根据患者畸形类型和柔韧性选择融合范围。术后及随访时在X线片上测量主弯冠状面的Cobb角、顶椎偏距、躯干偏移距离。结果：术后随访1～5年，平均28个月，冠状面Cobb角平均残留230，矫正率为59％；终末随访平均丢失4．5^o，丢失率为8％；顶椎偏距平均残留2．7cm，矫正率为55％，终末随访时平均丢失0．5cm。丢失率为8．5％；终末随访时躯干偏移距离平均1．4cm。结论：三维矫形内固定手术能有效改善AIS畸形。根据畸形特点选择正确的融合区进行适度的矫正是手术成功的关键。     

Lenke1BN型青少年特发性脊柱侧凸后路三维矫形有限元模拟研究

[目的]利用建立的Lenke1BN型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)三维有限元模型,模拟后路三维矫形手术,并探讨选择不同下固定椎对矫形效果的影响.[方法]应用建立的Lenke1BN型AIS有限元模型,模拟后路全椎弓根螺钉固定三维矫形手术.具体约束加载如下:约束骶骨整体水平固定,参照文献在T1～L5各椎节分别施加模拟自身重力和肌肉因素的向下载荷,在固定节段凹侧模拟植入"椎弓根螺钉",并放入"预弯"矫形钛棒,在棒末端施加向凹侧的旋转力矩,使棒向凹侧旋转90°,模拟旋棒矫形;旋棒同时在顶椎区(T7～10)固定螺钉施加10 Nm的扭矩,模拟椎体直接去旋转矫形.上固定椎选择T4(上端椎+2),下固定椎分别选择T12(中立椎)、L1(稳定椎)和L2(稳定椎+1),比较三种固定方案的矫形效果.[结果]顺利完成加载模拟矫形,选择T12(中立椎)、L1(稳定椎)和L2(稳定椎+1)作为下固定椎模拟矫形后,上胸弯、主胸弯和腰分别矫正为:7.1°、7.4°、9.2°,6.4°、6.8°、8.3°和6.5°、7.2°、8.6°;矢状面胸椎后凸(T5～12)分别为21.3°、20.7°和20.5°;三种矫形方案,矫形效果无显著差异.[结论]首次通过有限元模拟研究表明:对于中度Lenke1BN型AIS,选择性融合主胸弯可获得满意的腰弯自发矫正;应用全椎弓根螺钉固定结合顶椎区椎体去旋转技术,可将下固定椎从稳定椎上移至中立椎,减少远端融合节段.     

顶椎置钉与否对Lenke 1型青少年特发性脊柱侧凸矫形效果的影响

目的:探讨顶椎置钉与否对Lenke 1型青少年特发性脊柱侧凸(AIS)患者矫形效果的影响。方法:回顾性分析从2009年6月～2010年1月采用全椎弓根螺钉后路矫形内固定融合术治疗的69例Lenke 1型AIS患者,年龄12～20岁,平均15.0岁,主弯Cobb角50°～70°,平均53.7°。根据顶椎置钉与否分为:顶椎凸凹侧均未置入螺钉组(A组,35例)和至少一侧置入螺钉固定组(B组,34例)。记录两组患者术前年龄、性别、主弯Cobb角、柔韧度、顶椎旋转度和固定节段数、置入物密度、术后Cobb角、主弯Cobb角矫正率、顶椎去旋转率等指标并进行两组间的比较分析。B组病例在CT图像上统计顶椎不良置钉率。结果:两组患者年龄、性别比、术前主弯Cobb角、柔韧度和顶椎旋转度等资料均无统计学差异(P>0.05)。所有病例矫形术后均未发生冠状面与矢状面的失代偿。随访24～30个月,平均27.7个月,两组患者无内固定松动及断钉断棒,植骨融合牢固,均未出现明显的矫正丢失。A、B两组置入物密度分别为63.4%、65.3%,平均固定节段数分别为11.3和11.6,主弯Cobb角矫正率分别为73.9%和72.6%。两组在置入物密度、内固定节段数和主弯Cobb角矫正率方面均无统计学差异(P>0.05)。术后顶椎去旋转率A组为18.4%,显著低于B组的34.8%(P<0.05)。B组顶椎置入的41枚螺钉中,有5枚为不良置钉(12.2%)。结论:对于Cobb角在50°～70°非严重的Lenke 1型青少年特发性脊柱侧凸,顶椎置钉尽管并不能显著提高侧凸矫正率,但可以明显矫正顶椎旋转,因此,在注意置钉安全性的前提下,应尽量在顶椎置入椎弓根螺钉。     

后路选择性内固定矫形治疗青少年特发性脊柱侧凸

目的 评价经后路选择性关键椎体内固定矫形治疗青少年特发性脊柱侧凸（AIS）的临床疗效,探讨其手术适应证。方法经后路选择性关键椎体内固定矫形治疗的131例青少年AIS患者,术前均进行详细的临床和影像学检查评估,按影像学资料确定主侧凸顶椎、端椎、中立椎、稳定椎等关键椎体,并拟定关键椎体椎弓根螺钉内固定。结果主侧凸Cobb角由术前的平均51．3°±12．9°矫正至术后的平均8．9°±4．5°。131例均获得随访,时间8～52个月,末次随访时主侧凸Cobb角平均丢失4．6°±1．2°,椎弓根螺钉松动1例,未发现椎弓根螺钉及棒的断裂。结论经后路选择性关键椎体内固定矫形治疗青少年AIS可取得良好的临床疗效,减少患者医疗费用,符合我国实际国情,但术前应做好适应证选择。     

后路脊柱矫形术对右胸弯型女性青少年特发性脊柱侧凸患者乳房对称性的美学影响

【摘要】 目的：探讨后路脊柱矫形术对右胸弯型女性青少年特发性脊柱侧凸（adolescent idiopathic scoliosis,AIS）患者乳房对称性的美学影响。方法：回顾性分析2012年10月～2013年12月于我院行脊柱侧凸后路矫形术且有完整影像学及正面外观照片资料的60例乳房Tanner分级不小于3级的右胸弯型女性AIS患者,于其术前、术后外观照上测量凹凸侧的乳房美学指标,包括乳头间距（nipple-nipple length,NNL）、乳头至锁骨中点距离（clavicle-nipple length,CNL）、乳头至胸骨轴线距离（middle sternum-nipple length,MSNL）、乳头至胸骨上窝距离（sternal notch-nipple length,SNNL）、乳房内径（medial mammary radius,MR）、乳房下径（inferior mammary radius,IR）及乳房外倾角（α角）。乳房不对称程度定义为凹侧-凸侧的差值,其绝对值越小,不对称程度越低。采用配对t检验分别比较术前、术后凹凸侧乳房各个指标的不对称程度及手术对不对称程度的影响。结果：术前CNL、MSNL、SNNL、MR、IR、α角凹凸侧不对称程度分别为-1.7±7.1mm、3.0±7.2mm、2.4±8.4mm、7.5±6.6mm、1.3±3.9mm、-1.2°±5.1°,其中MSNL、SNNL、MR及IR在凹凸侧存在显著不对称差异（P<0.05）。术后CNL、MSNL、SNNL、MR、IR、α角凹凸侧不对称程度分别为3.3±6.0mm、2.5±6.8mm、3.4±8.4mm、7.2±6.9mm、0.2±4.4mm、-2.6°±5.3°,其中CNL、MSNL、SNNL、MR和α角在凹凸侧存在显著不对称差异（P<0.05）。配对t检验示CNL和α角的术后不对称程度显著加重（P<0.05）,SNNL术后不对称程度亦加重,但无统计学差异（P>0.05）。结论：脊柱矫形手术打破了右胸弯型女性AIS患者凹凸侧乳房美学指标在适应脊柱畸形发展过程中形成的相对平衡状态。术前相对对称的乳头至锁骨中点距离及乳房外倾角的凹凸侧不对称程度在术后明显变大,从而进一步加重了乳房的整体不对称程度。     

特发性脊柱侧凸术后躯干失平衡及其原因分析

目的 对62例行后路矫形的青少年特发性脊柱侧凸术前及术后躯干平衡情况进行回顾性观察，探讨术后躯干失平衡的可能原因。方法 回顾性分析1997年至2001年连续收治施行三维矫形手术的62例特发性脊柱侧凸患者。平均年龄14．4岁，术后平均随访时间35月(12月～57月)。进行CD、TSRH及CD Horizon系统的矫形内固定脊柱融合术，观察各型脊柱侧凸术后的躯干平衡情况。结果 有53例(85．5％)患者术前X线片检查提示冠状面有1cm以上的失平衡。失平衡以向左侧多见(占95％)，范围在-3．4cm到 4．3cm之间，平均为 3．1cm。48％的患者术后X线片检查仍有失平衡存在，但平均偏离距离为 1．2cm，较术前有显著改善。结论 三维矫形术后躯干失代偿的发生可能主要与融合节段尤其是下方融合节段选择不当有关。骨骼成熟度较低的患者，术后发生躯干失平衡的可能性大大增加。