不同侧凸方向的Lenke 5型脊柱侧凸前路矫形疗效的比较

Surgical outcomes of anterior instrumentation and fusion for Lenke 5 AIS: a comparison between the left and right curve

中文关键词:  青少年特发性脊柱侧凸  矫正率  矫正丢失  疗效

英文关键词:Adolescent idiopathic scoliosis  Correction rate  Loss of correction  Outcome

中文摘要:

  【摘要】 目的：比较不同侧凸方向的Lenke 5型脊柱侧凸前路矫形内固定的手术疗效。方法：对2005年1月~2009年12月期间在我院手术治疗的Lenke 5型青少年特发性脊柱侧凸（AIS）患者进行回顾分析。按照侧凸方向分为左侧凸组（L组，n=38）和右侧凸组（R组，n=14），在术前、术后及末次随访时的X线片上测量两组患者的如下参数：冠状面参数包括胸弯、胸腰弯/腰弯Cobb角及冠状面平衡等；矢状面参数有胸椎后凸角、胸腰段交界角、腰椎前凸角和整体矢状面平衡等。对两组病例的上述参数进行独立样本t检验，分析比较两组的矫形疗效。结果：两组术前主弯Cobb角、主弯累及节段及代偿胸弯Cobb角均无显著性差异（P＞0.05）。L组、R组平均随访时间分别为3.1±0.9年（2~4年）、2.7±0.8年（2~3年）。与L组相比，R组手术时间（208.8±41.4min vs. 225.6±39.6min）及出血量（236.5±159.6ml vs. 284.4±164.7ml）较多，但均无统计学差异（P=0.132和P=0.345）。L、R组腰弯平均矫正率分别为66.7%和64.4%（P=0.808），末次随访平均矫正丢失率分别为4.6%和5.1%（P=0.992）；L、R组胸弯平均矫正率分别为49.8%和47.7%（P=0.886），末次随访时平均矫正丢失率分别为13.4%和14.3%（P=0.759）。两组均无血管损伤及神经并发症，无1例发生内固定失败。L组术后2例患者发生远端Adding-on，1例患者发生近端交界性后凸；R组1例出现近端Adding-on。结论：前路胸腰弯/腰弯矫形融合术是治疗Lenke 5型脊柱侧凸的有效方法，且不同侧凸方向对矫形疗效无明显影响。

英文摘要:

  【Abstract】 Objectives: To investigate the influence of curve direction on surgical outcomes of anterior single-rod instrumentation and fusion for Lenke 5 adolescent idiopathic scoliosis(AIS). Methods: A retrospective review was performed on 52 patients who underwent surgery for Lenke 5 AIS at our clinic between January 2005 and December 2009. According to the direction of thoracolumbar/lumbar(TL/L) curve, the patients were divided into the left-sided group(group L, n=38) and the right-sided group(group R, n=14). The radiographic measurements were compared between the two groups at preoperation, postoperation and follow-up by using the Student′s t test: curve magnitude, coronal balance, thoracic kyphosis, thoracolumbar junctional angle, lumbar lordosis, sagittal vertical axial, and so on. Results: Preoperative Cobb angles of the TL/L and thoracic curves as well as the number of levels in TL/L curve were comparable between the two groups. Duration of follow-up for group L and R averaged 3.1±0.9 years and 2.7±0.8 years, respectively. Compared with group L, operation time and intraoperative blood loss were both found to be higher in group R though not reaching statistical significance(208.8±41.4min vs. 225.6±39.6min, P=0.132; 236.5±159.6ml vs. 284.4±164.7ml, P=0.345). The average TL/L curve correction was 66.7% in group L and 64.4% in group R(P=0.808), and at final follow-up, the loss of TL/L curve correction averaged 4.6% and 5.1%, respectively(P=0.992). With respect to the thoracic curve, the average correction and correction loss at final follow-up were found to be similar between the two groups(P=0.886 and P=0.759, respectively). Complications occurred in 4 of the patients, with one proximal junctional kyphosis and two distal adding-on presenting in group L, as well as one proximal adding-on in group R. There was no neurologic complication, vascular injury or implant failure noted untill final follow-up. Conclusions: Anterior single-rod instrumentation remains an effective surgical treatment for Lenke type 5 AIS, and there is no statistically significant difference comparing the left and the right TL/L curves.