中国修复重建外科杂志

中国修复重建外科杂志

Lenke 1 型青少年特发性脊柱侧弯矫形术中不同近端固定椎的疗效分析

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目的 探讨近端固定在上端椎上一椎体与上端椎治疗术前右肩高的 Lenke 1 型青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)的近期临床疗效。 方法 回顾分析 2010 年 1 月—2015 年 12 月行后路矫形手术治疗的 37 例 Lenke 1 型 AIS 患者临床资料,按照近端固定椎不同分为两组:A 组(17 例),近端固定至上端椎上一椎体;B 组(20 例),近端固定至上端椎。两组患者性别、年龄、Risser 征、双肩影像学高度差(radiographic shoulder height,RSH)、上胸弯柔韧度、主胸弯柔韧度、胸腰弯/腰弯柔韧度等一般资料比较差异无统计学意义(P>0.05)。术前、术后 1 个月及术后 1、2 年摄 X 线片测量主胸弯、上胸弯、胸腰弯/腰弯 Cobb 角,顶椎偏移距离(apical vertebral translation,AVT)、锁骨角(clavicle angle,CA)、RSH、躯干矢状位偏移、躯干冠状位偏移、胸椎后凸(thoracic kyphosis,TK)、腰椎前凸(lumbar lordosis,LL);并评价术后主胸弯矫正指标,包括术后 1 个月主胸弯矫正度和矫正率、AVT 矫正,术后 2 年主胸弯矫正丢失度和丢失率。 结果 A 组手术时间和术中出血量均显著大于 B 组(P<0.05)。两组患者均获随访,A 组随访时间 2~4 年,平均 2.8 年;B 组 2~3.5 年,平均 2.6 年。围手术期及随访期间均无神经损伤等严重并发症发生,无融合失败、内固定物松动断裂、邻近节段退变和近端交界性后凸等并发症发生。两组患者术后 1 个月主胸弯矫正度、主胸弯矫正率及 AVT 矫正,以及术后 2 年主胸弯矫正丢失度和主胸弯矫正丢失率比较差异均无统计学意义(P>0.05)。两组组内比较:除 LL 在手术前后各时间点间比较差异无统计学意义(P>0.05)外,其余各指标术后各时间点均较术前显著改善(P<0.05)。RSH、CA、上胸弯 Cobb 角、胸腰弯/腰弯 Cobb 角术后各时间点间比较差异均有统计学意义(P<0.05),且在术后随访过程中存在自发性矫正现象;而主胸弯 Cobb 角、 AVT、TK、躯干矢状位和冠状位偏移在术后各时间点间比较差异均无统计学意义(P>0.05),在术后随访过程中无明显丢失。两组组间比较:手术前后各时间点两组各影像学指标比较差异均无统计学意义(P>0.05)。 结论 对于术前右肩高的 Lenke 1 型 AIS 患者,近端固定椎选择上端椎即可获得满意的近期矫形效果,还可减少术中出血量和手术时间。

Objective To investigate the short-term effectiveness of proximal fixation of one vertebra above to the upper end vertebra and the upper end vertebra in the treatment of Lenke type 1 adolescent idiopathic scoliosis (AIS) patients with preoperative right higher shoulder. Methods The clinical data of 37 Lenke type 1 AIS patients treated with posterior correction between January 2010 and December 2015 were retrospectively analysed. According to proximal fixation vertebra, the patients were divided into 2 groups: group A (n=17), proximal fixation of one vertebra above to the upper end vertebra; group B (n=20), proximal fixation of the upper end vertebra. There was no significant difference in gender, age, Risser stage, radiographic shoulder height (RSH), flexibility of proximal thoracic curve, flexibility of main thoracic curve, flexibility of thoracolumbar/lumbar curve between 2 groups (P>0.05). The main thoracic curve Cobb angle, proximal thoracic curve Cobb angle, thoracolumbar/lumbar curve Cobb angle, apical vertebral translation (AVT), clavicle angle (CA), RSH, coronal trunk shift, sagittal trunk shift, thoracic kyphosis (TK), and lumbar lordosis (LL) were measured by X-ray film before operation, and at 1 month, 1 year, and 2 years after operation. The correction indexes of main thoracic curve were evaluated, including the correction degree and correction rate of main thoracic curve and AVT correction at 1 month after operation, the loss degree and the loss rate of the correction of main thoracic curve at 2 years after operation. Results The operation time and intraoperation blood loss in group A were significantly greater than those in group B (P<0.05). All the patients were followed up, and the follow-up time was 2-4 years (mean, 2.8 years) in group A and 2-3.5 years (mean, 2.6 years) in group B. No serious complication such as nerve damage occurred during perioperative period and follow-up period. No complication such as failure of fusion, loosening and rupture of internal fixator, adjacent segment degeneration, and proximal junctional kyphosis occurred. There was no significant difference between 2 groups in the correction degree and correction rate of main thoracic curve and AVT correction at 1 month after operation, the loss degree and the loss rate of the correction of main thoracic curve at 2 years after operation (P>0.05). Comparison within the two groups: except for LL had no significant difference between pre- and post-operation (P>0.05), the other indicators were significantly improved after operation (P<0.05) in the two groups. There were significant differences in RSH, CA, proximal thoracic curve Cobb angle, and thoracolumbar/lumbar curve Cobb angle at each time point after operation (P<0.05), and there were spontaneous correction during follow-up; however, there was no significant difference in main thoracic curve Cobb angle, AVT, TK, LL, trunk shift at each time point after operation (P>0.05), and there was no significant loss during follow-up. Comparison between the two groups: there was no significant difference in all the radiographic indexes at pre- and post-operation (P>0.05). Conclusion For Lenke type 1 AIS patients with preoperative right high shoulder, proximal fixation vertebra be fixed to the upper end vertebral can obtain satisfactory short-term orthopedic effectiveness and reduce blood loss and operation time.

关键词: 青少年特发性脊柱侧弯; Lenke 1 型; 近端固定椎; 上胸弯; 双肩平衡

Key words: Adolescent idiopathic scoliosis; Lenke type 1; proximal fixation vertebra; proximal thoracic curve; shoulder balance

引用本文: 朱欢叶, 李波, 简月奎, 孙泽宇, 杨震. Lenke 1 型青少年特发性脊柱侧弯矫形术中不同近端固定椎的疗效分析. 中国修复重建外科杂志, 2019, 33(1): 41-48. doi: 10.7507/1002-1892.201808015 复制

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