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| 青少年特发性脊柱侧凸主胸弯悬吊位和矫形术后Cobb角分布差异分析 |
| 刘延1,刘青山1,2,王梦真3,韩良丽3,杨长伟4,侯藏龙4*,张秋林4* |
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(1. 海军军医大学(第二军医大学)研究生院, 上海 200433;
2. 中国人民解放军联勤保障部队北戴河康复疗养中心, 秦皇岛 066199;
3. 海军军医大学(第二军医大学)第一附属医院麻醉科, 上海 200433;
4. 海军军医大学(第二军医大学)第一附属医院脊柱外科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 分析Lenke 1型青少年特发性脊柱侧凸（AIS）患者主胸弯Cobb角分布特征，以及不同节段间悬吊牵引法测得的柔韧性、矫正率、矫正指数的差异。方法 纳入2015年1月至2018年12月于海军军医大学（第二军医大学）第一附属医院行一期脊柱侧凸后路三维矫形融合内固定术的48例Lenke 1型AIS患者。将主胸弯分为近段（T5～T7或T6～T8）、中段（T7～T9或T8～T10）、远段（T9～T11或T10～T12），并测量各段的Cobb角。计算不同节段的侧弯柔韧性、矫正率和矫正指数（术后矫正率/术前侧弯柔韧性）。采用随机区组的方差分析进行统计学分析。结果 患者术前平均年龄为（14.31±2.24）岁，总Cobb角为（51.25±11.86）°，平均Risser分级为2.88±1.93；术后平均随访时间为（38.75±8.82）个月。术前近段Cobb角与远段Cobb角相似［（13.31±5.10）° vs （13.94±5.67）°，P＝0.757］，中段Cobb角［（24.00±5.61）°］大于近段及远段Cobb角（均P＜0.001）。术前近段、中段、远段Cobb角占总Cobb角的比例分别为（25.72±7.97）%、（47.08±5.22）%、（27.20±8.00）%。术前远段侧弯柔韧性高于近段和中段［（64.01±24.18）% vs （35.00±18.02）%、（41.49±17.65）%，均P＜0.001］。术后1周，近段、中段、远段矫正率分别为（74.61±15.80）%、（65.66±16.36）%和（73.76±19.41）%，差异无统计学意义（P＝0.280）；矫正指数分别为2.41±1.20、2.03±1.45和1.49±1.31，近段矫正指数高于远段（P＝0.040）。末次随访时，近段、中段、远段矫正率分别为（71.10±14.07）%、（62.39±13.47）%和（69.75±17.53）%，差异无统计学意义（P＝0.226）；矫正指数分别为2.24±1.10、1.92±1.30和1.39±1.10，近段的矫正指数高于远段（P＝0.026）。结论 在Lenke 1型AIS患者中，近段、中段和远段Cobb角分别占主胸弯的25.72%、47.08%、27.20%。悬吊牵引法对远段柔韧性的评估能力最强，即悬吊位下远端节段最灵活，而各节段术后矫正率无明显差异。 |
| 关键词: 青少年特发性脊柱侧凸 柔韧性 悬吊牵引法 Cobb角 矫正率 |
| DOI：10.16781/j.CN31-2187/R.20230769 |
| 投稿时间：2023-12-26修订日期：2024-05-07 |
| 基金项目: |
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| Differences in distribution of Cobb angles in main thoracic curve suspension position and post-correction in adolescent idiopathic scoliosis |
| LIU Yan1,LIU Qingshan1,2,WANG Mengzhen3,HAN Liangli3,YANG Changwei4,HOU Canglong4*,ZHANG Qiulin4* |
(1. Graduate School, Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Beidaihe Rehabilitation and Recuperation Center, Joint Logistics Support Force of PLA, Qinhuangdao 066199, Hebei, China;
3. Department of Anesthesiology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China;
4. Department of Spinal Surgery, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
*Corresponding authors) |
| Abstract: |
| Objective To compare the distribution characteristics of the main thoracic curve Cobb angle in Lenke type 1 adolescent idiopathic scoliosis (AIS) patients, and differences in flexibility, correction rate, and correction index measured by different segmental suspension traction methods. Methods Totally 48 Lenke type 1 AIS patients, who underwent one-stage posterior 3-dimensional spinal deformity correction with bone graft fusion and internal fixation in The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 2015 to Dec. 2018, were enrolled. The main thoracic curve was divided into proximal (T5-T7 or T6-T8), middle (T7-T9 or T8-T10), and distal (T9-T11 or T10-T12) segments, and Cobb angles were measured for each segment. Flexibility, correction rate, and correction index (correction rate/preoperative flexibility) were calculated for different segments. Statistical analysis was performed using the analysis of variance of randomized block for comparison. Results The preoperative average age was (14.31±2.24) years, the total Cobb angle was (51.25±11.86)°, and the average Risser grade was 2.88±1.93. The average follow-up time was (38.75±8.82) months. The preoperative Cobb angle of the proximal segment was similar to that of the distal segment (［13.31±5.10］ ° vs ［13.94±5.67］ °, P＝0.757), and the Cobb angle of the middle segment (24.00±5.61)° was greater than that of the proximal and distal segments (both P＜0.001). The proportions of the proximal, middle and distal Cobb angle to the total Cobb angle were (25.72±7.97)%, (47.08±5.22)% and (27.20±8.00)%, respectively. Preoperative lateral flexion flexibility of the distal segment was significantly higher than that of the proximal and middle segments (［64.01±24.18］% vs ［35.00±18.02］%, ［41.49±17.65］%, both P＜0.001). The correction rates at 1 week postoperatively were as follows: proximal segment (74.61±15.80)%, middle segment (65.66±16.36)%, and distal segment (73.76±19.41)%, with no significant difference (P＝0.280). The correction indexes were as follows: proximal segment 2.41±1.20, middle segment 2.03±1.45, and distal segment 1.49±1.31, and the correction index of the proximal segment was significantly higher than that of the distal segment (P＝0.040). At the last follow-up, the correction rates were: proximal segment (71.10±14.07)%, middle segment (62.39±13.47)%, and distal segment (69.75±17.53)%, with no significant difference (P＝0.226). The correction indexes were as follows: proximal segment 2.24±1.10, middle segment 1.92±1.30, and distal segment 1.39±1.10, and the correction index of the proximal segment was significantly higher than that of the distal segment (P＝0.026). Conclusion In Lenke type 1 AIS patients, the proximal, middle, and distal segments account for 25.72%, 47.08%, and 27.20% of the main thoracic curve Cobb angle, respectively. The suspension traction method has the strongest ability to evaluate the flexibility of the distal segment, that is, the distal segment is most flexible under the suspension position, and the postoperative correction rate of each segment is similar. |
| Key words: adolescent idiopathic scoliosis flexibility suspension traction method Cobb angle correction rate |
