| 摘要: |
| 目的 探讨青少年特发性脊柱侧凸患者双下肢不等长（LLD）与脊柱侧凸的关系，并分析矫形手术后LLD的改善情况及影响LLD改善的危险因素。方法 回顾性分析2010年1月至2013年1月在海军军医大学（第二军医大学）长海医院骨科脊柱外科就诊的85例青少年特发性脊柱侧凸患者的病例资料。根据患者术前及术后2年的影像学资料测量分析站立位X线片双侧股骨头高度差（HD-bFH）及矫形术后该参数的变化。根据患者术前HD-bFH，将患者分为非LLD组（HD-bFH<5 mm）和LLD组（HD-bFH≥5 mm），比较两组患者的一般特征和影像学参数的差异，并分析HD-bFH变化与其他参数的相关性。结果 85例患者术前HD-bFH为（0.80±5.57）mm，术后2年患者HD-bFH为（－0.49±4.93）mm，术后与术前相比差异有统计学意义（P=0.022）。主胸弯型（LenkeⅠ、Ⅱ、Ⅲ型，n=50）和胸腰弯/腰弯型（LenkeⅤ和Ⅵ型，n=33）患者术前HD-bFH差异无统计学意义[（0.52±5.86）mm vs（1.53±5.12）mm，P=0.427]。85例患者中，31例（36.5%）发生LLD。非LLD（n=54）与LLD（n=31）患者的一般特征和影像学参数差异无统计学意义（P>0.05）。术后HD-bFH的变化与Risser征（rs=－0.512，P=0.020）及腰弯矫形程度（r=－0.605，P=0.018）相关。结论 本研究中青少年特发性脊柱侧凸患者LLD的发生率为36.5%。双下肢长度差异的改变与矫形手术密切相关，腰弯矫形程度和Risser征是其危险因素。 |
| 关键词: 青少年 特发性脊柱侧凸 双下肢不等长 危险因素 Risser征 矫形外科手术 |
| DOI：10.16781/j.0258-879x.2019.04.0362 |
| 投稿时间：2018-12-24修订日期：2019-03-21 |
| 基金项目:国家自然科学基金（31870985），上海市青年科技英才扬帆计划（19YF1447100）. |
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| Relationship between orthopedic surgery for adolescent idiopathic scoliosis and leg length discrepancy |
| CHEN Kai,YANG Yi-lin,ZHAO Jian,YANG Ming-yuan,YANG Chang-wei*,LI Ming* |
(Department of Spine Surgery, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding authors) |
| Abstract: |
| Objective To explore the relationship between leg length discrepancy (LLD) and scoliosis in adolescent idiopathic scoliosis (AIS) patients, and to analyze the improvement of LLD after orthopaedic surgery and the risk factors. Methods The clinical data were collected from 85 AIS patients admitted to Department of Spine Surgery of Changhai Hospital, Naval Medical University (Second Military Medical University) from Jan. 2010 to Jan. 2013. The height difference of bilateral femoral head (HD-bFH) on standing X-ray images and the changes of HD-bFH after orthopaedic surgery were measured using the imaging data before operation and 2 years after operation. According to preoperative HD-bFH, the patients were divided into non-LLD group (HD-bFH<5 mm) and LLD group (HD-bFH ≥ 5 mm). The general characteristics and imaging parameters were compared between the two groups, and the correlation between HD-bFH changes and other parameters was analyzed. Results The HD-bFH of the 85 AIS patients was (0.80±5.57) mm before operation and (-0.49±4.93) mm 2 years after operation, and the difference was significant (P=0.022). There was no significant difference in HD-bFH between the patients with main thoracic curves (Lenke typeⅠ, Ⅱand Ⅲ; n=50) and thoracolumbar/lumbar curves (Lenke type Ⅴ and Ⅵ, n=33;[0.52±5.86] mm vs[1.53±5.12] mm, P=0.427). Among the 85 patients, 31 (36.5%) had LLD. There were no significant differences in general features and imaging parameters between the non-LLD group (n=54) and the LLD group (n=31, P>0.05). Postoperative change of HD-bFH was correlated with Risser sign (rs=-0.512, P=0.020) and the orthopedic degree of lumbar curvature (r=-0.605, P=0.018). Conclusion The prevalence of LLD is 36.5% in AIS patients. Changes of leg length in AIS patients are closely related to orthopedic surgery, and the orthopedic degree of lumbar curvature and Risser sign are the risk factors. |
| Key words: adolescent idiopathic scoliosis leg length discrepancy risk factors Risser sign orthopedic procedures |
