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| Lenke 5C型青少年特发性脊柱侧凸置钉上棒矫形顺序的研究 |
| 林徐苗1△,陈锴2△,邵杰2,杨明园2,刘佳昊1,张国友2,石志才2,白玉树2* |
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(1. 海军军医大学(第二军医大学)第一附属医院麻醉学部疼痛治疗科, 上海 200433;
2. 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
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 分析不同置钉上棒矫形顺序对Lenke 5C型青少年特发性脊柱侧凸（AIS）的手术效果。方法 选择2013年1月至2020年12月在我院行后路矫形植骨融合内固定术的Lenke 5C型AIS患者，其中采用双侧置钉后先凸侧上棒矫形再行凹侧上棒矫形的患者22例（双侧组）、采用凸侧置钉上棒矫形后再行凹侧置钉上棒矫形的患者20例（凸侧组）。比较两组患者的手术相关指标（如手术时间等）、术前及术后2年时患者的影像学参数、生活质量评分，同时分析并发症的发生情况。结果 双侧组的手术时间长于凸侧组，差异有统计学意义［（232.8±13.1） min vs （198.4±16.5） min，P＜0.01］。术后2年末次随访时凸侧组主弯Cobb角及其矫正率均优于双侧组［（8.0±2.3）° vs （9.9±3.2）°，P＝0.03；（81.9±5.4）% vs （77.8±5.8）%，P＝0.02）］；双侧组和凸侧组的椎弓根螺钉破壁率分别为5.4%（17/312）和1.4%（4/280），差异有统计学意义（P＜0.01）。术后2年末次随访时双侧组生活质量评估的治疗满意度为（4.61±1.38）分，凸侧组为（4.50±1.44）分，但两组间差异无统计学意义（P＞0.05）。两组患者术中均无电生理监测异常及手术相关并发症发生。结论 对于Lenke 5C型AIS患者，采用凸侧置钉上棒矫形后再行凹侧置钉上棒矫形的手术效果更好。 |
| 关键词: 青少年特发性脊柱侧凸 Lenke 5C型 脊柱侧凸矫形术 矫形顺序 矫形效果 |
| DOI：10.16781/j.CN31-2187/R.20240128 |
| 投稿时间：2024-02-23修订日期：2024-05-07 |
| 基金项目: |
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| Orthopedic sequence of nailing on rods in patients with Lenke type 5C adolescent idiopathic scoliosis |
| LIN Xumiao1△,CHEN Kai2△,SHAO Jie2,YANG Mingyuan2,LIU Jiahao1,ZHANG Guoyou2,SHI Zhicai2,BAI Yushu2* |
(1. Department of Pain Medicine, Faculty of Anesthesiology, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China;
2. Department of Spinal Surgery, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To compare the surgical outcomes of the sequence of screw and rod placement for Lenke type 5C adolescent idiopathic scoliosis (AIS). Methods Lenke type 5C AIS patients who underwent posterior orthopedic fusion and fixation in our hospital from Jan. 2013 to Dec. 2020 were recruited. Based on surgical sequences, 22 cases were assigned to bilateral group (after bilateral screw placement, orthopedics was performed on the convex side and then on the concave side), and 20 cases were assigned to convex group (screws placed on the convex side and performed orthopedics, followed by the concave side). The operation-related indicators (including operation time), imaging parameters, quality of life scores were compared between the 2 groups before and 2 years after surgery. Complications of the 2 groups were analyzed. Results The operation time in the bilateral group was significantly longer than that in the convex group (［232.8±13.1］ min vs ［198.4±16.5］ min, P＜0.01). At the last follow-up 2 years after operation, the Cobb angle and its correction rate in the convex group were better than those in the bilateral group (［8.0±2.3］° vs ［9.9±3.2］°, P＝0.03; ［81.9±5.4］% vs ［77.8±5.8］%，P＝0.02). The rate of pedicle screw breach rate was 5.4% (17/ 312) in the bilateral group and 1.4% (4/280) in the convex group, with significant difference (P＜0.01). At the last follow-up 2 years after operation, the treatment satisfaction of quality of life assessment of the bilateral group was 4.61±1.38, and that of the convex group was 4.50±1.44, but there was no significant difference between the 2 groups (P＞0.05). There were no abnormal electrophysiological monitoring or operation-related complications in the 2 groups. Conclusion For Lenke type 5C AIS, the convex side of pedicle screw placement and orthopedics followed by concave side of pedicle screw placement and orthopedics can achieve better surgical effect. |
| Key words: adolescent idiopathic scoliosis Lenke type 5C scoliosis orthopedics orthopedic sequence orthopedic effects |
