摘要
目的:回顾分析青少年特发性脊柱侧凸术后即刻哪些影像学参数与术后长期随访时融合区下方临近节段退变相关联,指导手术治疗。方法:共有64名诊断为青少年特发性脊柱侧凸(LenkeⅠ或Ⅱ型)的患者纳入分析,所有患者采用后路全椎弓根螺钉系统手术治疗。术前、术后两周及术后末次随访(至少术后两年)时记录各项影像学数据,主要包括冠状面指标、矢状面指标、肩平衡指标及融合区远端平衡指标。分析这些指标与术后末次随访时融合区下方临近节段成角及楔形变的相关性。结果:融合区下方椎间隙成角术前为3.65°±4.25°,术后两周为1.78°±2.44°,末次随访时为2.21°±6.78°。末次随访时的融合区下方椎间隙成角与术后即刻椎间隙成角、矢状面平衡以及融合下终椎偏移相关(r2=0.7433,P<0.0001)。末次随访时的融合下终椎倾斜与术后即刻的下终椎成角、腰椎前凸、下终椎偏移以及冠状面平衡相关(r2=0.8879,P<0.0001)。结论:对于青少年特发性脊柱侧凸行全椎弓根螺钉系统矫形术后融合区下方临近的椎间隙成角、下终椎倾斜或偏移时,极易发生术后远期的临近节段倾斜或椎间隙楔形变,从而导致躯干失平衡。所以详尽的术前评估及选择正确的融合节段以及术中保持融合下终椎的水平对于术后发生躯干失平衡相当重要。
Objective：To investigate which radiographic parameters immediately after posterior spinal fusion for adolescent idiopathic scoliosis best correlate with subjacent discwedging follow-up.Methods：Sixty-four consecutive adolescent idiopathic scoliosis patients who underwent posterior pedicle screw-only instrumentation were studied retrospectively Preoperative and postoperative radiographs were obtained to measure various parameters regarding global coronal,shoulder,sagittal and regional balance.Specific correlation of these parameters to selected 2-year postoperative disc wedging and lowest instrumented vertebra（LIV）tilt and translation were analyzed.Results：The average disc angle changed from 3.65±4.25 preoperatively to 1.78±2.44 at 2-weeks and 2.21±6.78 at 2years postoperatively.Two-year postoperative disc angle significantly correlated with 2-week postoperative disc angle,plumbline relative to the posterior superior corner of the first sacral vertebra distance and LIV-center sacral vertical line distance（r2= 0.7433,P0.0001）.Twoyear postoperative LIV tilt significantly correlated with 2-week postoperative LIV tilt distance（r2 =0.8879,P 0.0001）.Conclusion：LIV tilt and LIV translation occurred most often when disc wedging and LIV deviation or obliquity existed immediately postoperatively.Our study has identified a potential indicator for adolescent idiopathic scoliosis repair.Preoperative surgical planning and intraoperative correction are important to avoid subjacent regional imbalance after scoliosis fusion.
出处
《甘肃医药》
2013年第5期331-334,共4页
Gansu Medical Journal
