| 摘要: |
| 目的 分析青少年特发性脊柱侧凸（AIS）患者脊柱后路截骨矫形植骨融合内固定术后不同下固定椎脊柱骨盆矢状面参数的差异。方法 回顾性分析2010年1月至2019年11月于我院行脊柱后路截骨矫形植骨融合内固定术的49例AIS患者的一般资料及术前和最近1次随访时（术后随访至少24个月）的影像学参数，包括胸椎后凸角（TK）、腰椎前凸角（LL）、矢状面轴向偏距（SVA）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）及近胸弯、主胸弯、胸腰弯/腰弯Cobb角，并计算PI－LL。根据下固定椎将患者分为T12~L2组和L3~L5组，比较两组患者的一般资料和影像学参数。结果 T12~L2组31例AIS患者，L3~L5组18例AIS患者。两组患者的年龄、性别、随访时间、Risser征、融合椎体数差异均无统计学意义（P均＞0.05）。术前两组患者的SVA、PI、PT、SS、TK、LL和PI－LL差异均无统计学意义（P均＞0.05）。最近1次随访时，L3~L5组的LL较术前增大（P＝0.001），T12~L2组的LL较术前减小（P＝0.027），T12~L2组和L3~L5组PI－LL均较术前增大[1.8°（－4.0°，8.7°）vs 0.3°（－4.7°，5.7°）、－10.1°（－14.4°，－8.8°）vs 1.7°（－7.3°，5.6°），P＝0.016、0.002]，L3~L5组的PI－LL变化值大于T12~L2组（P＜0.001）。结论 对于AIS患者，脊柱后路截骨矫形植骨融合内固定术中远端固定至L3~L5时，术后LL会增大，引起PI与LL不匹配，这可能影响脊柱骨盆矢状面平衡，术前应根据PI预测合适的LL以避免术中过度弯棒。 |
| 关键词: 青少年特发性脊柱侧凸 矢状面平衡 远端融合 骨盆入射角 腰椎前凸角 脊柱骨盆矢状面参数 |
| DOI：10.16781/j.CN31-2187/R.20220164 |
| 投稿时间：2022-02-25 |
| 基金项目: |
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| Changes of sagittal spino-pelvic parameters after surgery in adolescent idiopathic scoliosis patients |
| ZHANG Yi,SHAO Jie,LI Wei,LI Xiong-fei,BAI Yu-shu* |
(Department of Spinal Surgery, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To analyze the differences in sagittal spino-pelvic parameters among adolescent idiopathic scoliosis (AIS) patients who underwent posterior spinal osteotomy orthopedic implant fusion and internal fixation with different distal fixed vertebrae.Methods The general data and imaging parameters of 49 AIS patients who underwent posterior spinal osteotomy orthopedic implant fusion and internal fixation in our hospital between Jan. 2010, and Nov. 2019 were analyzed retrospectively. The imaging parameters were measured preoperatively and at the last follow-up (at least 24 months after operation), including thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and the Cobb angles of proximal thoracic curve, main thoracic curve and thoracolumbar/lumbar curve, and PI－LL was calculated. According to the distal fixed vertebrae, the patients were divided into T12-L2 group and L3-L5 group. The general data and imaging parameters were compared between the 2 groups.Results There were 31 AIS patients in the T12-L2 group and 18 AIS patients in the L3-L5 group. There were no significant differences in age, gender, follow-up duration, Risser sign, or number of fused vertebrae between the 2 groups (all P > 0.05). There were no significant differences in SVA, PI, PT, SS, TK, LL, or PI－LL between the 2 groups before operation (all P > 0.05). Compared with those before operation, at the last follow-up, the LL was significantly increased in the L3-L5 group (P＝0.001) while significantly decreased in the T12-L2 group (P＝0.027), and the PI－LL was significantly increased in the T12-L2 and L3-L5 groups (1.8°[－4.0°, 8.7°] vs 0.3°[－4.7°, 5.7°]and －10.1°[－14.4°, －8.8°] vs 1.7°[－7.3°, 5.6°], P＝0.016 and 0.002). At the last follow-up, the change of PI－LL in the L3-L5 group was significantly greater than that in the T12-L2 group (P < 0.001).Conclusion For AIS patients, postoperative LL may increase when distal fixation is at L3-L5 during posterior spinal osteotomy orthopedic implant fusion and internal fixation, resulting in the mismatch between PI and LL, which may affect the sagittal spino-pelvic balance. The appropriate LL should be predicted according to PI before operation to avoid excessive bending of the rod during operation. |
| Key words: adolescent idiopathic scoliosis sagittal balance distal fusion pelvic incidence lumbar lordosis sagittal spino-pelvic parameters |
