椎弓根螺钉系统重建Lenke 1型青少年特发性脊柱侧凸患者的胸椎后凸10年前后疗效比较

Restoration of thoracic kyphosis with all pedicle screw system in Lenke 1 AIS patients: if improve after 10-year training

中文关键词:  青少年特发性脊柱侧凸  胸椎后凸  椎弓根螺钉系统

英文关键词:Adolescent idiopathic scoliosis  Thoracic kyphosis  All pedicle screw system

中文摘要:

  【摘要】 目的：比较椎弓根螺钉系统重建Lenke 1型青少年特发性脊柱侧凸（AIS）患者胸椎后凸10年前后的疗效差异。方法：分别从2005年6月～2006年6月（早期组）和2014年6月～2015年6月（近期组）于我院脊柱外科行手术治疗的Lenke 1型AIS患者中分别随机选取40例，共80例患者纳入研究。术前、术后即刻及随访1年左右摄立位全脊柱正侧位X线片，测量如下影像学参数：冠状面Cobb角、矢状面平衡（sagittal vertical axis，SVA）、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、颈椎前凸角（cervical lordosis，CL）、骨盆投射角（pelvic incidence，PI）、骶骨倾斜角（sacral slope，SS）、骨盆倾斜角（pelvic tilt，PT）。通过独立样本t检验比较早期组患者与近期组患者之间的术前、术后影像学参数差异情况。结果：两组患者手术时年龄分别为14.94±1.78岁及14.96±2.01岁。早期组患者的术前TK平均为14.42°±7.92°，而近期组的术前TK则为15.19°±7.90°，在术前两组间的TK差异并无统计学意义（P=0.681）。在进行后路矫形手术后，早期组的术后即刻TK为18.58°，而近期组则为19.23°，两组间的差异同样无统计学意义（P=0.689）。在随访中，两组的TK与术后即刻的TK相比并无显著差异。相关性分析显示在术前和术后TK与CL均显著相关。结论：目前椎弓根螺钉系统相比于10年前对于Lenke 1型AIS患者的胸椎后凸的重建并无显著区别，这种变化可能与AIS本身的病因学有关，也可能与本中心采用的去旋转矫形技术有关。

英文摘要:

  【Abstract】 Objectives: To investigate the change of thoracic kyphosis(TK) correction in Lenke 1 adolescent idiopathic scoliosis(AIS) patients with all pedicle screw constructs after 10-year revolution. Methods: In this retrospective study, 80 Lenke 1 AIS patients who underwent posterior correction surgery with all pedicle screw construct in our center were included. 40 patients were selected randomly with the operation time during June 2005 to June 2006, while the other 40 patients were from June 2014 to June 2015. Long-cassette standing upright posterior-anterior and lateral radiographs of the spine and pelvis were taken before and two weeks after surgery. The radiographic parameters including Cobb angle, sagittal vertical axis(SVA), TK, lumbar lordosis(LL), cervical lordosis(CL), pelvic incidence(PI), sacral slope(SS), pelvic tilt(PT). Independent t test was conducted to assess difference in terms of radiographic parameters pre- and post-operatively between 2 groups. Results: The mean age was 14.94±1.78 years old and 14.96±2.01 years old respectively. The baseline TK averaged 14.42°±7.92° in early group and 15.19°±7.90° in recent group. No significant difference was observed in terms of TK at baseline(P=0.681). After posterior correction surgery, TK was restored to 18.58° in early group and 19.23° in recent group. Still, no significant difference was observed(P=0.689). Correlation analysis revealed that TK was significantly correlated to CL both at baseline and post-operation. Conclusions: No improvement was found in TK restoration compared to 10 years ago. The stable outcome may be related to the etiology of AIS or the derotation maneuver in our center.