Lenke 1C型青少年特发性脊柱侧凸选择性融合术后参数变化Alterations of spino-pelvic alignment after selective posterior fusion for Lenke 1C adolescent idiopathic scoliosis
姜横;孟怡晨;李唐波;周许辉;
摘要(Abstract):
[目的]研究经椎弓根螺钉内固定选择性融合术后Lenke 1C型AIS患者矢状面参数的变化及与冠状面参数或骨盆参数之间的相关关系。[方法]选择41例连续观察的Lenke 1C型特发性脊柱侧凸患者,均行后路椎弓根螺钉固定、选择性融合术。术后随访2年。术前、术后2个月、术后2年均行站立位全脊柱正侧位X线片检查,并行影像学测量与统计。[结果]平背畸形组(胸椎后凸角<20°)患者,术后2个月(19.59±9.59)°、2年(20.45±3.59)°与术前(11.82±3.32)°比较,胸椎后凸角明显增加(P=0.010),术后2个月与2年比较,胸椎后凸角能保持稳定(P=0.998)。胸椎后凸角术后2年变化量与腰椎前凸角2年变化量、术前腰椎前凸角、骨盆投射角呈显著性相关(r值分别为-0.652,0.635,0.805,P值分别为0.041,0.049,0.005)。[结论]椎弓根螺钉内固定系统能改善平背畸形Lenke1C型患者的胸椎后凸。选择性融合术中,胸椎后凸的纠正在维持脊柱矢状位平衡中发挥重要作用。
关键词(KeyWords): 青少年特发性脊柱侧弯;椎弓根螺钉;选择性融合;矢状面平衡
基金项目(Foundation):
作者(Author): 姜横;孟怡晨;李唐波;周许辉;
Email:
DOI:
参考文献(References):
- [1]Crawford CH,Lenke LG,Sucato DJ,et al.Selective thoracic fusion in Lenke 1C curves:prevalence and criteria[J].Spine(Phila Pa1976),2013,38(16):1380-1385.
- [2]Schulz J,Asghar J,Bastrom T,et al.Optimal radiographical criteria after selective thoracic fusion for patients with adolescent idiopathic scoliosis with a C lumbar modifier:does adherence to current guidelines predict success[J].Spine(Phila Pa 1976),2014,39(23):E1368-1373.
- [3]Upasani VV,Tis J,Bastrom T,et al.Analysis of sagittal alignment in thoracic and thoracolumbar curves in adolescent idiopathic scoliosis:how do these two curve types differ[J].Spine,2007,32(12):1355-1359.
- [4]Mac-Thiong JM,Labelle H,Berthonnaud E,et al.Sagittal spinopelvic balance in normal children and adolescents[J].Eur Spine J,2007,16(2):227-234.
- [5]Mac-Thiong JM,Labelle H,Charlebois M,et al.Sagittal plane analysis of the spine and pelvis in adolescent idiopathic scoliosis according to the coronal curve type[J].Spine,2003,28(13):1404-1409.
- [6]Ries Z,Harpole B,Graves C,et al.Selective thoracic fusion of lenke I and II curves affects sagittal profiles but not sagittal or spinopelvic alignment:a case-control study[J].Spine,2015,40(12):926-934.
- [7]Clément J,Geoffray A,Yagoubi F,et al.Relationship between thoracic hypokyphosis,lumbar lordosis and sagittal pelvic parameters in adolescent idiopathic scoliosis[J].Eur Spine J,2013,22(11):2414-2420.
- [8]Khakinahad M,Ameri E,Ghandhari H,et al.Preservation of thoracic kyphosis is critical to maintain lumbar lordosis in the surgical treatment of adolescent idiopathic scoliosis[J].Acta Med Iran,2012,50(7):477-481.
- [9]Roussouly P,Labelle H,Rouissi J,et al.Pre-and post-operative sagittal balance in idiopathic scoliosis:a comparison over the ages of two cohorts of 132 adolescents and 52 adults[J].Eur Spine J,2013,22(2):203-215.
- [10]Kim YJ,Lenke LG,Cho SK,et al.Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis[J].Spine,2004,29(18):2040-2048.
- [11]Kim YJ,Lenke LG,Kim J,et al.Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis[J].Spine,2006,31(3):291-298.
- [12]Li M,Shen Y,Fang X,et al.Coronal and sagittal plane correction in patients with Lenke 1 adolescent idiopathic scoliosis:a comparison of consecutive versus interval pedicle screw placement[J].JSpinal Disord Tech,2009,22(4):251-256.
- [13]Potter BK,Kuklo TR,Lenke LG.Radiographic outcomes of anterior spinal fusion versus posterior spinal fusion with thoracic pedicle screws for treatment of Lenke Type I adolescent idiopathic scoliosis curves[J].Spine,2005,30(16):1859-1866.
- [14]Lehman RA,Lenke LG,Keeler KA,et al.Operative treatment of adolescent idiopathic scoliosis with posterior pedicle screw-only constructs:minimum three-year follow-up of one hundred fourteen cases[J].Spine,2008,33(14):1598-1604.
- [15]Yilmaz G,Borkhuu B,Dhawale AA,et al.Comparative analysis of hook,hybrid,and pedicle screw instrumentation in the posterior treatment of adolescent idiopathic scoliosis[J].J Pediatr Orthop,2012,32(5):490-499.
- [16]Yang M,Yang C,Chen Z,et al.Lumbar lordosis minus thoracic kyphosis:remain constant in adolescent idiopathic scoliosis patients before and after correction surgery[J].Spine,2015,41(6):E359-E363.
- [17]Min K,Sdzuy C,Farshad M.Posterior correction of thoracic adolescent idiopathic scoliosis with pedicle screw instrumentation:results of 48 patients with minimal 10-year follow-up[J].Eur Spine J,2013,22(2):345-354.
- [18]Blondel B,Lafage V,Schwab F,et al.Reciprocal sagittal alignment changes after posterior fusion in the setting of adolescent idiopathic scoliosis[J].Eur Spine J,2012,21(10):1964-1971.
- [19]Ilgenfritz RM,Yaszay B,Bastrom TP,et al.Lenke 1C and 5C spinal deformities fused selectively:5-year outcomes of the uninstrumented compensatory curves[J].Spine,2013,38(8):650-658.
- [20]Mac-Thiong JM,Berthonnaud E,Dimar JR,et al.Sagittal alignment of the spine and pelvis during growth[J].Spine,2004,29(15):1642-1647.
- [21]Legaye J,Duval-Beaupignme A,Hecquet J,et al.Pelvic incidence:a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves[J].Eur Spine J,1998,7(2):99-103.
- [22]Boulay C,Tardieu C,Hecquet J,et al.Sagittal alignment of spine and pelvis regulated by pelvic incidence:standard values and prediction of lordosis[J].Eur Spine J,2006,15(4):415-422.
- [23]Yong Q,Zhen L,Zezhang Z,et al.Comparison of sagittal spinopelvic alignment in Chinese adolescents with and without idiopathic thoracic scoliosis[J].Spine,2012,37(12):714-720.
- [24]Lafage V,Schwab F,Vira S,et al.Spino-pelvic parameters after surgery can be predicted:a preliminary formula and validation of standing alignment[J].Spine,2011,36(13):1037-1045.(收稿:2016-09-22修回:2016-11-12)