后路矫形手术对青少年特发性脊柱侧凸患者脊柱高度的影响

The influence of posterior corrective surgery on surgical spinal height in adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  矫正身高  矫形手术

英文关键词:Adolescent idiopathic scoliosis  Surgical height gain  Correction surgery

中文摘要:

  要】 目的：评估后路矫形手术对青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者脊柱高度的矫正程度及其影响因素。方法：2010年1月~2011年6月接受后路矫形内固定术的AIS患者277例，单弯（single curve，SC）173例，双弯（double curve，DC）104例，站立位主弯Cobb角平均53.63°±15.38°（40°~140°），仰卧位主弯Cobb角43.87°±15.01°（20°~124°）。脊柱高度（spinal height，SH）定义为仰卧位全脊柱正位X线片上T1椎体上终板中点至S1椎体上终板中点之间的垂直距离。测量术前、术后SH，ΔSH为手术矫正SH值。评估不同Cobb角侧凸患者的ΔSH，并采用偏相关分析评估脊柱侧凸术前Cobb角、Cobb角矫正值、Cobb角矫正率、术前SH及术后SH与ΔSH的相关性。结果：SC组仰卧位Cobb角术后矫正至15.69°±9.21°（4°~79°），DC组仰卧位主弯Cobb角术后矫正至19.50°±13.07°（3°~95°），矫正率分别为69.7%和65.5%。SC组和DC组术前SH分别为41.29±2.96cm和39.97±3.26cm，术后SH分别为43.77±2.71cm和42.86±3.04cm。SC组术前仰卧位Cobb角分别为≤30°、31°~40°、41°~50°、51°~60°、61°~70°、71°~80°、>80°时，ΔSH分别为1.97±0.79cm、2.14±0.63cm、2.52±0.65cm、2.77±0.51cm、3.92±0.61cm、4.33±0.22cm、4.85±0.22cm；而在DC组中，ΔSH分别为2.37±0.60cm、2.35±0.69cm、2.56±0.53cm、3.27±0.40cm、3.79±0.94cm、3.89±1.11cm、5.46±0.91cm。ΔSH与术前Cobb角[SC：r=0.702，P<0.001；DC（主弯+次发弯）：r=0.718，P<0.001]、Cobb角矫正值[SC：r=0.659，P<0.001；DC（主弯+次发弯）：r=0.698，P<0.001]和术后SH[SC：r=0.182，P=0.017；DC（主弯+次发弯）：r=0.213，P=0.033]呈显著相关性，但与Cobb角矫正率[SC：r=0.083，P>0.05；DC（主弯+次发弯）：r=0.039，P>0.05]和术前SH[SC：r=-0.082，P>0.05；DC（主弯+次发弯）：r=-0.047，P>0.05]无明显相关性。结论：后路矫形手术可显著改善AIS患者的SH，术前Cobb角和Cobb角矫正值是影响SH矫正程度的主要因素，术后SH是次要影响因素，而Cobb角矫正率则影响不大。

英文摘要:

  【Abstract】 Objectives: To evaluate the spinal height recovery introduced by surgery in adolescent idiopathic scoliosis(AIS) patients, and to identify the predictive factors responsible for it. Methods: This study included 277 AIS patients undergoing correction surgery from January 2010 to June 2011. There were 173 single-curve(SC) and 104 double-curve(DC) idiopathic scoliosis cases. The mean magnitude of the major curves was 53.63°±15.38° in standing position(range 40°-140°) and 43.87°±15.01° in supine position(range 20°-124°). For each patient, the height(SH) of the spinal column was measured as the vertical distance from the upper endplate of T1 to the upper endplate of S1 in an full-length antero-posterior radiograph taken from a supine.postion before and after surgery, ΔSH was defined as the change in SH. Association between pre-op Cobb angle, corrected magnitude of Cobb angle, correction rate, pre-op SH, post-op SH and ΔSH were assessed partial correlation analysis. Results: The supine major Cobb angle was corrected to 15.69°±9.21°(range 4°-79°) postoperatively in single curve(SC) group, and 19.50°±13.07°(range 3°-95°) in DC group, with the correction rate of 69.7% and 65.5% respectively. In SC group, the average SH was improved from 41.29±2.96cm to 43.77±2.71cm after surgery, while the corresponding figures for DC group were from 39.97±3.26cm to 42.86±3.04cm. The height recovery averaged 1.97±0.79cm, 2.14±0.63cm, 2.52±0.65cm, 2.77±0.51cm, 3.92±0.61cm, 4.33±0.22cm, 4.85±0.22cm for Cobb angle within ≤30°, 31°-40°, 41°-50°, 51°-60°, 61°-70°, 71°-80°, >80° in SC group, respectively. Accordingly the figures of DC group were 2.37±0.60cm, 2.35±0.69cm, 2.56±0.53cm, 3.27±0.40cm, 3.79±0.94cm, 3.89±1.11cm, 5.46±0.91cm, respectively. There was a significant correlation between Height recovery and pre-op Cobb angle[SC group: r=0.702, P<0.001; DC group(major+minor): r=0.718, P<0.001], corrected magnitude of Cobb angle[SC group: r=0.659, P<0.001; DC group(major+minor): r=0.698, P<0.001] and post-op SH[SC group: r=0.182, P=0.017; DC group(major+minor): r=0.213, P=0.033]. However. It was not significantly related to the correction rate[SC group: r=0.083, P>0.05; DC group(major+minor): r=0.039, P>0.05] and pre-op SH[SC group: r=-0.082, P>0.05; DC group(major+minor): r=-0.047, P>0.05]. Conclusions: Posterior corrective surgery can significantly improve the spinal height in AIS patients. The major influential factors for ΔSH include pre-op Cobb angle and corrected magnitude of Cobb angle, while the post-op SH is no more than a secondary factor, nor was the correction rate of Cobb angle.