选择性融合对Lenke 1型青少年特发性脊柱侧凸患者站立和坐位腰椎与骨盆矢状面平衡的影响

Effect of selective fusion on the balance of lumbar vertebrae and pelvis sagittal plane in standing and sitting position of Lenke 1 adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  矢状面平衡  腰骶骨盆参数  站立位  坐位

英文关键词:Adolescent idiopathic scoliosis  Sagittal balance  Lumbosacral pelvic parameters  Standing position  Sitting position

中文摘要:

  【摘要】　目的：探讨选择性融合对Lenke　1型青少年特发性脊柱侧凸（ＡＩＳ）患者站立位和坐位腰椎与骨盆矢状面平衡的影响。方法：2013年4月～2015年4月在我院行后路矫形融合术的24例Lenke　1型AIS患者作为研究对象，年龄11～15岁（13.0±1.8岁）。Lenke　1A型12例，Lenke　1B型5例，Lenke　1C型7例。根据手术融合节段将患者分为选择性融合组（STF组，n=13，下端融合至Ｌ１　８例，Ｌ２　５例）和非选择性融合组（NSTF组，n=1１，下端融合至Ｌ３）。随访６～１７个月（１４．０±４．２个月），所有患者均拍摄术前、术后及末次随访时的站立位和坐位全脊柱正侧位Ｘ线片，并测量L3/4、L4/5及L5/S1的椎间角、骶椎倾斜角（SS）、骨盆入射角（PI）以及骨盆倾斜角（PT）等影像学参数，分别比较手术前后和末次随访时站立位和坐位的矢状面参数变化。所有患者均在手术前和末次随访时填写22项脊柱侧凸研究学会调查问卷（SRS-22）评估其生活质量。结果：所有患者在手术前、手术后及末次随访由站立位改为坐位时，L3/4、L4/5、L5/S1椎间角以及SS均减小，而PT增加（P＜0.05）；手术前后及末次随访时PI基本不变（P＞0.05）；术后与末次随访时相应的矢状面参数无显著性差异（P＞0.05）。STF组手术前、手术后及末次随时站立位与坐位PT和SS均有显著性差异（P＜0.05）；NSTF组中手术前站立位与坐位PT和SS有显著性差异（P＜0.05），而在术后及末次随访时无显著性差异（P＞0.05）。手术前，STF组与NSTF组患者SRS-22评分在四个项目中均无显著性差异（P＞0.05）；末次随访时，STF组与NSTF组患者在功能与疼痛两个项目中存在显著性差异（P＜0.05），在自我形象、心理状况及术后满意度上均无显著性差异（P＞0.05）。结论：对于Lenke　1型ＡＩＳ患者，与非选择性融合相比，选择性融合不仅在维持腰椎活动性方面具有重要价值，而且保留了从站位到坐位时骨盆后旋的代偿功能。

英文摘要:

  【Abstract】 Objectives: To investigate the changes of lumbar spine and pelvic sagittal plane in standing and sitting positions before and after orthopedic surgery as well as at short-term follow-up of Lenke　1 adolescent idiopathic scoliosis(AIS).　Methods: A total of 24 Lenke　1　AIS patients who underwent posterior orthopedic fusion in our center from April 2013 to April 2015 was selected, aged from 11 to 15 years(average, 13.0±1.8 years), including 12 cases of Lenke　1A type, 5 cases of Lenke　1B type, and 7 cases of Lenke 1C type. Patients were divided into a selective fusion group(STF group, n=13) and a non-selective fusion group(NSTF, n=11) according to the surgical fusion segment. All patients underwent preoperative, postoperative and finalfollow-up standing and sitting full-spine positive lateral radiographs. The following parameters were measured: L3/4, L4/5 and L5/S1 intervertebral angles, sacral slope(SS), pelvis imaging parameters such as pelvic incidence(PI) and pelvic tilt(PT). The changes of sagittal parameters in standing and sitting positions were compared between immediately after surgery and at final follow-up. All patients were required to complete the 22-item Scoliosis Research Society questionnaire(SRS-22) before surgery and at final follow-up. Results: All patients had a decrease in L3/4, L4/5, L5/S1 intervertebral angle and SS, while PT increased from standing to sitting position at pre- and post-operation and final follow-up. PI remained unchanged from before to after surgery(P>0.05). There was no significant difference in the corresponding sagittal parameters between at post-operation and at final follow-up(P>0.05). There were significant differences of PT and SS between preoperation and postoperation in the STF group(P<0.05). However, In the NSTF group, there was a significant difference between the standing and sitting PT and SS preoperative(P<0.05), but no significant difference between postoperative and final follow-up(P>0.05). Before surgery, there was no significant difference in SRS-22 scores between the STF group and the NSTF group in all the four items(P>0.05). At final follow-up, there were significant differences between the STF group and the NSTF group in the two items of function and pain(P<0.05), and there was no significant difference in self-image, psychological status or postoperative satisfaction(P>0.05). Conclusions: For Lenke 1 AIS, STF not only has important value in maintaining lumbar motion, but also retains the compensatory function of pelvic posterior rotation from standing to sitting position when compared with NSTF.