胸椎半椎体后路切除术后冠状面失代偿的危险因素分析

Risk factors of coronal decompensation following posterior hemivertebra resection in patients with thoracic hemivertebra

中文关键词:  先天性脊柱侧凸  胸椎半椎体  冠状面失代偿  半椎体切除术  风险因素

英文关键词:Congenital scoliosis  Thoracic hemivertebra  Coronal decompensation  Hemivertebra resection  Risk factors

中文摘要:

  【摘要】 目的：分析胸椎半椎体切除、椎弓根螺钉固定融合术后冠状面失代偿发生的危险因素。方法：回顾性分析2011年1月~2019年1月在我科行单纯后路半椎体切除、植骨融合椎弓根螺钉内固定术治疗的57例胸椎单发半椎体畸形患者的临床资料，按照术后末次随访时是否出现冠状面失代偿分为失代偿组（n=7）和对照组（无任何继发畸形，n=50）。收集两组患者术前及末次随访的临床以及影像学资料，比较两组患者接受手术时年龄、Risser征、主弯Cobb角、近端固定椎（UIV）倾角、UIV偏距、远端固定椎（LIV）倾角、LIV偏距以及LIV椎间盘开角等，并通过多因素分析以上指标与术后冠状面失代偿发生的相关性，利用ROC曲线法计算相关指标的阈值。结果：失代偿组男4例、女3例，年龄4～14岁（11.1±3.5岁），其中1例＜10岁、6例10～14岁；对照组男27例、女23例，年龄4～17岁（10.2±3.6岁），其中26例＜10岁、17例10～14岁、7例14～18岁。两组患者性别分布无显著性差异（P=0.697），年龄段分布有显著性差异（P=0.032），失代偿组10~14岁比例显著高于对照组。失代偿组患者Risser征0~2级6例，3~6级1例；对照组0～2级20例，3~5级30例，失代偿组Risser征0~2级比例显著高于对照组（P＜0.05）。失代偿组患者术前UIV倾角与LIV倾角分别为29.5°±10.4°和22.1°±11.8°，均显著大于对照组的13.2°±6.4°和14.9°±7.5°（P＜0.05）。多因素分析显示年龄（OR值1.401）、Risser征（OR值0.357）、术前UIV倾角（OR值1.230）、术前LIV倾角（OR值1.309）与术后冠状面失代偿发生显著性相关（P＜0.05）；术前UIV倾角的阈值为19.2°，术前LIV倾角的阈值为17.6°。结论：10～14岁、且Risser征0～2级的胸椎半椎体畸形患者术后易出现冠状面失代偿；术前UIV倾角≥19.2°、LIV倾角≥17.6°是术后冠状面失代偿发生的潜在危险因素。

英文摘要:

  【Abstract】 Objectives: To analyze the risk factors of coronal decompensation after posterior thoracic hemivertebra resection, pedicle screw fixation and fusion. Methods: Data of 57 patients with single thoracic hemivertebra who received posterior hemivertebra resection and pedicle screw fixation and fusion in our department from January 2011 to January 2019, were retrospectively analyzed. Among them, 7 patients occurred coronal decompensation after surgery were included in the decompensation group, while 50 patients without any secondary deformity were included in the control group. Both clinical data and radiographic parameters before surgery and at the last follow-up were collected in this study. The age, Risser sign, main curve Cobb angle, upper instrument vertebra(UIV) tilt angle, UIV translation, lower instrument vertebra(LIV) tilt angle, LIV translation, and LIV disc wedge angle were compared between decompensation and control groups. And the correlation between the above parameters and postoperative decompensation was analyzed by multivariate analysis. The cut-off value was calculated by ROC curve. Results: Decompensation group included 4 males and 3 females, averaged 10.2±3.6 years(4 to 14 years old) with 1 patient <10 years old and 6 patients between 10 to 14 years old. Control group included 27 males and 23 females, averaged 10.2±3.6 years(4 to 17 years old)with 26 patients <10 years old, 17 patients between 10 to 14 years old and 7 patients between 14 to 18 years old. There was no difference in gender distribution(P=0.697) but significant difference in age distribution between the two groups(P=0.032). The decompensation group had more patients between 10－14 years old. Decompensation group included 6 patients of Risser sign grade 0 to 2 and 1 patient of grade 3 to 5, while control group had 20 patients of Risser sign grade 0 to 2 and 30 patients of grade 3 to 5. The ratio of grade 0－2 patients were significant higher in decompensation group(P=0.029). The preoperative UIV tilt angle and LIV tilt angle in the decompensation group were 29.5°±10.4° and 22.1°±11.8° respectively, which were significantly larger than those in the control group(13.2°±6.4° and 14.9°±7.5°, P<0.05). Multivariate analysis showed age (OR=1.401), Risser sign (OR=0.357), preoperative UIV(OR=1.230), preoperative LIV(OR=1.309) were the risk factors for postoperative coronal decompensation(P<0.05). The cut-off value of preoperative UIV tile angle was 19.2° while the preoperative LIV tilt angle was 17.6°. Conclusions: The thoracic hemivertebra patients aged 10 to 14 years old with Risser sign between grade 0 to 2 have a very high risk for coronal decompensation; and the preoperative UIV tilt angle ≥19.2° or LIV tilt angle ≥17.6° may be the risk factor for coronal decompensation after operation.