| 摘要: |
| 目的 评估伴左肩低的Lenke 2A型青少年特发性脊柱侧凸（AIS）患者上胸弯融合与术后远端叠加现象的相关性。方法 回顾性分析2010年7月16日至2018年10月21日于我院行脊柱后路胸腰椎融合术的104例术前左肩低的Lenke 2A型AIS患者资料，所有患者均获得至少2年的随访，并通过X线片测量影像学参数。根据手术上端固定椎（UIV）的选择将患者分为≥T3组（UIV在T3及T3以上）和＜T3组（UIV在T3以下），比较两组术前、术后及末次随访时的影像学参数、远端叠加发生率及生活质量（脊柱侧凸研究协会22项问卷评分）。结果 104例患者平均年龄为（14.8±3.2）岁，平均随访时间为（33.0±9.6）个月。≥T3组71例，＜T3组33例，两组术前临床及影像学参数匹配（P＞0.05）。末次随访时，27例（26.0%）患者发生远端叠加，≥T3组远端叠加的发生率高于＜T3组［31.0%（22/71） vs 15.2%（5/33），P＜0.001］；15例（14.4%）患者发生术后肩部不平衡（PSI），其中≥T3组11例（15.5%），＜T3组4例（12.1%）；两组患者生活质量评分差异无统计学意义（P＞0.05）。多因素logistic回归分析显示，Risser分级和UIV选择是伴左肩低Lenke 2A型AIS患者术后发生远端叠加的独立影响因素（均P＜0.05）。结论 对于伴左肩低的Lenke 2A型AIS患者，UIV的选择与术后远端叠加发生率有关，融合上胸弯或将导致远端叠加风险增加。 |
| 关键词: 青少年特发性脊柱侧凸 脊柱后路胸腰椎融合术 远端叠加 上端固定椎 上胸弯 |
| DOI：10.16781/j.CN31-2187/R.20230465 |
| 投稿时间：2023-08-15修订日期：2024-05-07 |
| 基金项目:国家自然科学基金（82002260），南京鼓楼医院临床研究专项资金项目培育项目（2022-LCYJ-PY-39）. |
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| Lenke type 2A adolescent idiopathic scoliosis with low left shoulder: excessive fusion of proximal thoracic curve increases the risk of distal adding-on |
| CHEN Xipu,QIN Xiaodong,CHEN Yi,HE Zhong,LIU Zhen,QIU Yong,ZHU Zezhang* |
(Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu, China
*Corresponding author) |
| Abstract: |
| Objective To evaluate the correlation between proximal thoracic curve fusion and postoperative distal adding-on in Lenke type 2A adolescent idiopathic scoliosis (AIS) patients with low left shoulder. Methods The data of 104 patients with Lenke type 2A AIS with low left shoulder who underwent posterior thoracolumbar fusion in our hospital were retrospectively analyzed. All patients were followed up for at least 2 years, and the imaging parameters were measured by X-ray. The patients were divided into ≥T3 group (upper instrumented vertebra ［UIV］ at T3 or above T3) and ＜T3 group (UIV below T3) according to the choice of UIV. The imaging parameters, the incidence of distal adding-on and the quality of life (scoliosis research society-22 questionnaire score) were compared between the 2 groups before and after operation and at the last follow-up. Results The average age of the 104 patients was (14.8±3.2) years old, and the average follow-up time was (33.0±9.6) months. There were 71 cases in ≥T3 group and 33 cases in ＜T3 group. The preoperative clinical and imaging parameters of the 2 groups were matched (P＞0.05). At the last follow-up, 27 (26.0%) patients had distal adding-on, and its incidence in ≥T3 group was significantly higher than that in ＜T3 group (31.0% ［22/71］ vs 15.2% ［5/33］, P＜0.001). Postoperative shoulder imbalance (PSI) occurred in 15 (14.4%) patients, including 4 (12.1%) patients in ＜T3 group and 11 (15.5%) patientsin ≥T3 group. There was no significant difference in quality of life scores between the 2 groups (P＞0.05). Multivariate logistic regression analysis showed that Risser grade and UIV selection were independent influencing factors for postoperative distal adding-on in Lenke type 2A AIS patients with low left shoulder (both P＜0.05). Conclusion For patients with Lenke type 2A AIS and lower left shoulder, the choice of UIV is related to the incidence of distal adding-on after operation. For such patients, the fusion of the proximal thoracic curve may increase the risk of distal adding-on. |
| Key words: adolescent idiopathic scoliosis posterior thoracolumbar fusion adding-on upper instrumented vertebra proximal thoracic curve |
