不同矫形手术方式对成人特发性脊柱侧凸患者小脑扁桃体位置的影响

The influence of different corrective procedures on cerebellar tonsillar position in patients with adult idiopathic scoliosis

中文关键词:  成人特发性脊柱侧凸  小脑扁桃体  手术方式  磁共振成像

英文关键词:Adult idiopathic scoliosis  Cerebellar tonsil  Surgical management  Magnetic resonance imaging

中文摘要:

  【摘要】 目的：探讨经后路不同手术矫形方式对成人特发性脊柱侧凸（adult idiopathic scoliosis，ADIS）患者小脑扁桃体位置的影响，并分析其与脊柱畸形矫正程度的相关性。方法：回顾性分析2018年9月～2025年9月于昆明医科大学第二附属医院骨科住院行外科手术治疗的成人特发性脊柱侧凸患者40例，根据手术方式差异分为后路全脊椎切除术（posterior vertebral column resection，PVCR）组（n=10）与后路脊柱单纯矫形固定融合术（posterior spinal fusion，PSF）组（n=30）。所有患者均于脊柱全长X线片上测量Cobb角（Cobb angle，CA）、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、冠状面平衡距离（coronal balance distance，CBD）及矢状面平衡距离（sagittal vertical axis，SVA）；颈椎MRI正中矢状位测量小脑扁桃体位置。采用独立样本t检验比较两组间患者小脑扁桃体位置变化及脊柱参数；配对样本t检验比较组内患者手术前、后小脑扁桃体位置变化差异；Pearson相关分析法进行小脑扁桃体移位程度与脊柱畸形矫正程度的相关性分析；GraphPad Prism 8.0绘制相关性热图。结果：PVCR组在手术时间、手术出血量、Cobb角及TK上显著大于PSF组，差异具有统计学意义（P<0.05）；PVCR组与PSF组术后小脑扁桃体位置均高于术前，两组内患者手术前后小脑扁桃体位置差异显著（P<0.05），均向头侧移位，且PVCR组移位更明显。相关性分析中，小脑扁桃体移位程度与△Cobb角、△TK呈中度正相关（r=0.371、0.448，P=0.018、0.004）。结论：成人特发性脊柱侧凸患者行外科矫形手术后小脑扁桃体位置出现向头侧移位趋势，接受PVCR者移位程度更显著，移位程度与脊柱侧凸或后凸畸形矫正程度呈中度正相关。

英文摘要:

  【Abstract】 Objectives: To investigate the impact of different posterior surgical correction procedures on the alteration of cerebellar tonsil position in patients with adult idiopathic scoliosis(ADIS), and to analyze the correlation between tonsillar displacement and the degree of spinal deformity correction. Methods: A retrospective analysis was conducted on 40 ADIS patients who underwent surgical treatment in the Department of Orthopedics at the Second Affiliated Hospital of Kunming Medical University between September 2018 and September 2025. Patients were stratified into two cohorts according to the surgical procedure: the posterior vertebral column resection(PVCR) group(n=10) and the posterior spinal fusion(PSF) group(n=30). Radiographic parameters, including the Cobb angle(CA), thoracic kyphosis(TK), lumbar lordosis(LL), coronal balance distance(CBD), and sagittal vertical axis(SVA), were measured on standing full-length spine radiographs. The position of the cerebellar tonsils was measured on midsagittal cervical magnetic resonance imaging(MRI). An independent samples t-test was employed to compare intergroup differences in cerebellar tonsil positional changes and spinal parameters. Paired-samples t-tests were utilized to assess intragroup differences in tonsil position pre- and post-operatively. Pearson correlation analysis was performed to evaluate the relationship between the degree of cerebellar tonsillar displacement and the magnitude of spinal deformity correction. Correlation heatmaps were generated using GraphPad Prism 8.0 software. Results: The PVCR group exhibited significantly longer operative time, greater intraoperative blood loss, and larger CA and TK compared with the PSF group(P<0.05). Postoperative cerebellar tonsil positions in both the PVCR and PSF groups demonstrated significant cephalad migration compared to preoperative levels(P<0.05), with the PVCR group exhibited a more pronounced degree of displacement. Pearson correlation analysis revealed a moderate positive correlation between the degree of cerebellar tonsillar displacement and △CA and △TK(r=0.371, P=0.018; r=0.448, P=0.004). Conclusions: ADIS patients exhibit a tendency toward cephalad migration of the cerebellar tonsils following surgical correction. Patients undergoing PVCR procedures demonstrate a more significant degree of displacement. The extent of tonsillar displacement appears to be moderately positively correlated with the degree of correction of coronal scoliosis and sagittal kyphosis.