青少年特发性脊柱侧凸后路矫形后远端交界区变化

Distal junctional changes in adolescent idiopathic scoliosis following posterior correction

中文关键词:  青少年特发性脊柱侧凸  椎弓根螺钉  远端交界区变化  后路矫形

英文关键词:Adolescent idiopathic scoliosis  Pedicle screw  Distal junctional changes  Posterior cprrection

中文摘要:

  【摘要】 目的：探讨青少年特发性脊柱侧凸（AIS）患者后路矫形术后远端交界区（LIV+2）在冠状面、矢状面和轴位上的变化。方法：2005年6月~2007年6月手术治疗AIS患者32例，男6例，女26例，年龄10～19岁，平均14.4岁。按PUMC分型，Ⅰc 1例，Ⅱa 4例，Ⅱb1 9例，Ⅱb2 1例，Ⅱc1 1例，Ⅱc3 5例，Ⅱd1 5例，Ⅲa 5例，Ⅲb 1例。均采用后路全节段椎弓根螺钉系统矫形固定，其中远端融合椎（LIV）与稳定椎（SV）为同一椎体（A组）15例，LIV与SV非同一椎体（B组）17例。术前和末次随访时摄站立位全脊柱正侧位X线片，测量冠状面上躯干偏移（TS），LIV的倾斜度（LIVT），LIV尾侧椎间盘开角（LIVA），冠状面和矢状面上远端交界区的Cobb角和椎体的旋转度（LIV+1 VR 和LIV+2 VR）。结果：随访24～36个月，平均29个月。两组末次随访时的TS与术前比较均无显著性差异（P>0.05）。A组LIVT由术前20.2°±5.9°下降到末次随访时的4.7°±3.8°（P＜0.001），B组由17.2°±5.5°下降到4.4°±2.7°（P＜0.001）；A组术前和末次随访时LIVA分别为7.5°±4.7°和3.9°±3.1°（P＝0.056）；B组分别为4.5°±3.4°和5.4°±3.2°（P＝0.492）；Pearson′s相关分析显示两组远端融合椎倾斜度变化和其尾侧椎间盘开角变化之间相关性不显著（A组r＝-0.067，P=0.813；B组r＝0.362，P=0.154）。A组远端交界区（LIV+2）冠状面上Cobb角由术前20.5°±9.6°矫正至末次随访时9.4°±7.3°（P＜0.001）；B组由13.8°±6.7°矫正至8.1°±4.7°（P=0.013）；A、B组末次随访时远端交界区矢状面上Cobb角与术前比较均无显著性差异（分别为P＝0.464，P=0.598）；Pearson′s相关分析显示A组末次随访时矢状面Cobb角和术前矢状面Cobb角之间相关性不显著（r＝0.076，P＝0.788），B组的相关性显著（r＝0.803，P＜0.001）。两组末次随访时LIV+1 VR和LIV+2 VR与术前比较均无显著性差异（P>0.05）。结论：AIS患者应用后路全节段椎弓根螺钉系统矫正后远端交界区在冠状面上矫形明显，矢状面和轴位上矫形不明显，且远端融合椎倾斜度减小。

英文摘要:

  【Abstract】 Objective：To investigate distal junctional changes on the coronal，saggital and axial plane in adolescent idiopathic scoliosis（AIS） undergoing posterior correction.Method：32 AIS cases from June 2005 to June 2007 undergoing surgery were reviewed retrospectively.There were 6 males and 26 females with an average age of 14.4 years（range，10 to 19 years old）．The curve types included PUMCⅠc 1 case，Ⅱa 4 cases，Ⅱb 9 cases，Ⅱb2 1 case，Ⅱc1 1 case，Ⅱc3 5 cases，Ⅱd1 5 cases ，Ⅲa 5 cases，Ⅲb 1 case.All of them undergoing posterior correction using pedicle screw constructs alone were divided into 2 groups：group A，15cases，with the lowest instrumented vertebrae（LIV） of stable vertebrae（SV）（SV=LIV）；group B，17cases，with LIV of not the stable vertebrae（SV≠LIV）.Radiographic measurements from standing anterio-posterior and lateral radiographs before surgery and at final follow-up including trunk shift（TS），lowest instrumented vertebrae tilt（LIVT），distal disc angulation（LIVA），coronal and sagittal Cobb angle of distal junction（LIV+2），axial rotation of distal junction（LIV+1 vertebral rotation and LIV+2 vertebral rotation） were collected and analyzed.Result：The average follow-up was 29 months（range，24 to 36 months）.There were no statistic difference in TS before surgery and at final follow-up in both groups（P＞0.05）.The LIVT was corrected from 20.2°±5.9° before surgery to 4.7°±3.8° at final follow-up（P＜0.001） in group A and 17.2°±5.5° to 4.4°±2.7°（P＜0.001） in group B.The LIVA was corrected from 7.5°±4.7° before surgery to 3.9°±3.1° at final follow-up（P＝0.056） in group A and 4.5°±3.4° to 5.4°±3.2°（P＝0.492） in group B.The LIVA change was not significantly correlated with the change of the LIVT in both group（group A：r＝-0.067，P=0.813；group B：r＝0.362，P=0.154）.The coronal Cobb of LIV+2 improved significantly from 20.5°±9.6° before surgery to 9.4°±7.3° at final follow-up（P＜0.001） in group A and 13.8°±6.7° to 8.1°±4.7°（P=0.013） in group B.There was no significant difference in saggital curve correction of LIV+2 in both groups（group A：P＝0.464，group B：P=0.598）.The correlation of saggital curve correction was not significant in group A（r＝0.076，P＝0.788） while significant in group B（r＝0.803，P＜0.001）.There were no significant difference of LIV+2 curve axial correction in both groups（P＞0.05）.Conclusion：The distal junctional correction for AIS due to pedicle screw fixation is more significant on the coronal plane rather than the sagittal plane and axial plane，meanwhile the lowest instrumented vertebrae tilt is decreased after surgery.