锥束CT拼接成像联合工形测量仪在青少年特发性脊柱侧凸矫形术中冠状位平衡评估的应用

Application of cone-beam CT mosaic imaging combined with I-shaped measurement instrument in assessing the coronal balance during corrective surgery for adolescent idiopathic scoliosis

中文关键词:  青少年特发性脊柱侧凸  后路矫形术  冠状位平衡  锥束CT  拼接脊柱全长片

英文关键词:Adolescent idiopathic scoliosis  Posterior orthopedic  Coronal balance  Cone-beam CT  Mosaic full-spine X-ray

中文摘要:

  【摘要】 目的：探讨锥束CT拼接成像联合工形测量仪在青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者矫形术中冠状位平衡评估的应用价值。方法：收集2019年1月~2021年1月在北部战区总医院接受脊柱后路矫形手术且术中均应用锥束CT拼接成像技术联合工形测量仪评估冠状位平衡情况的48例AIS患者的相关资料，患者年龄12~18岁（14.9±1.8岁），随访时间1~2年（1.8±0.2年）。根据冠状位平衡情况进行分型：A型为冠状位平衡距离（coronal balance distance，CBD）＜20mm，B型为CBD≥20mm且C7铅垂线位于主弯的凹侧，C型为CBD≥20mm且C7铅垂线在主弯的凸侧，将CBD≥20mm定义为冠状位失平衡。记录所有患者术前、术中、术后1周、末次随访时的主弯Cobb角、CBD、骨盆冠状倾角（pelvic coronal obliquity angle，PCOA）以及术前、末次随访时疼痛视觉模拟评分（visual analogue scale，VAS）及Oswestry功能障碍指数（Oswestry disability index，ODI），比较不同时间点的冠状位平衡情况及临床矫形效果。结果：48例患者术前、术中、术后1周及末次随访时主弯Cobb角分别为58.45°±12.81°、14.13°±5.86°、14.48°±5.98°、14.39°±5.74°，术中及术后1周较术前均有明显改善（P＜0.05），末次随访与术后1周差异无统计学意义（P＞0.05）；术前、术中、术后1周及末次随访时PCOA分别为3.72°±2.75°、1.25°±0.97°、1.25°±0.96°、1.28°±0.96°，其中术中及术后1周较术前均有明显差异（P＜0.05），末次随访与术后1周差异无统计学意义（P＞0.05）。所有患者术前冠状位失平衡率为47.91%（23/48），末次随访时冠状位失衡率为10.42%（5/48）。A型组25例患者术前、术中、术后1周及末次随访时的CBD分别为12.53±4.46mm、8.06±3.15mm、8.37±3.13mm、8.66±3.77mm，术中与术后1周较术前均有明显改善（P＜0.05），末次随访与术后1周差异均无统计学意义（P＞0.05）；B型组15例及C型组8例患者术前、术中、术后1周及末次随访时的CBD分别为24.57±4.60mm、14.91±4.62mm、14.95±4.49mm、15.06±3.98mm及26.46±6.78mm、16.58±4.00mm、16.94±4.12mm、16.58±3.97mm，两组患者术中与术后1周较同组术前均有明显改善（P＜0.05），末次随访与同组术后1周差异均无统计学意义（P＞0.05）。所有患者末次随访时VAS评分（3.98±0.57分）及ODI[（21.82±3.12）%]较术前[（7.68±0.64）分、（46.51±4.79）%]均有明显改善（P＜0.05）。结论：锥束CT拼接成像联合工形测量仪是一种有效且整体平衡评估能力强的术中冠状位平衡评估方法，能够更好地辅助脊柱外科医生在AIS患者脊柱侧凸矫形术中进行冠状位平衡的评估，及时调整矫形程度，有效减少术后冠状位失衡发生。

英文摘要:

  【Abstract】 Objectives: To investigate the values of cone-beam CT(CBCT) mosaic imaging combined with I-shaped measurement instrument in assessing coronal balance during the correction surgery for patients with adolescent idiopathic scoliosis(AIS). Methods: Clinical data of 48 AIS patients treated with posterior spinal correction surgery and assessed for coronal balance by CBCT mosaic imaging an I-shaped measurement instrument in the General Hospital of Northern Theater Command from January 2019 to January 2021 were retrospectively analyzed. The patients aged 14.9±1.8(12-18) years and were followed up for 1.8±0.2(1-2) years. They were classified based on the conditions of coronal balance as follows: Type A, coronal balance distance(CBD)<20mm; Type B, CBD≥20mm and C7 plumb line(C7PL) shifted to the concave side of the main curve; Type C, CBD≥20mm and C7PL shifted to the convex side of the main curve. CBD≥20mm was defined as coronal imbalance. The main curve Cobb angle, CBD and pelvic coronal obliquity angle(PCOA) before and during surgery, at 1 week after the surgery and the last follow-up visit were recorded. In addition, visual analogue scale(VAS) scores and Oswestry disability index(ODI) before operation and at the last follow-up were recorded. Parameters reflecting the coronal balance and clinical orthopedic effect at each time point were compared. Results: The main curve Cobb angles of 48 AIS patients before operation, during operation, at 1 week after operation and the last follow-up were 58.45°±12.81°, 14.13°±5.86°, 14.48°±5.98° and 14.39°±5.74°, respectively, which were significantly reduced during operation and at 1 week after operation compared with that before surgery(P<0.05), and which were not significantly different between postoperative 1 week and the last follow-up(P>0.05). The PCOAs before operation, during operation, at 1 week after surgery and the last follow-up were 3.72°±2.75°, 1.25°±0.97°, 1.25°±0.96° and 1.28°±0.96°, respectively. A significant difference was detected in intraoperative PCOA and postoperative PCOA(P<0.05); While no significant difference was detected between the PCOA at 1 week after surgery and the last follow-up visit(P>0.05). The coronal imbalance rate was 47.91%(23/48) before operation and 10.42%(5/48) at final follow-up. The CBDs of the type A 25 patients before surgery, during surgery, at 1 week after surgery and the last follow-up were 12.53±4.46mm, 8.06±3.15mm, 8.37±3.13mm and 8.66±3.77mm, respectively. The intraoperative and postoperative 1 week CBDs were significantly reduced compared with before surgery(P<0.05), and no significant difference was found between those of postoperative 1 week and the last follow-up(P>0.05). The CBDs of type B 15 patients before surgery, during surgery, at 1 week after surgery and the last follow-up were 24.57±4.60mm, 14.91±4.62mm, 14.95±4.49mm and 15.06±3.98mm, which in type C 8 patients were 26.46±6.78mm, 16.58±4.00mm, 16.94±4.12mm and 16.58±3.97mm, respectively. CBDs during surgery and at 1 week after surgery in both type B and C patients were significantly reduced compared with those before the surgery(P<0.05), and no significant difference was detected between those at 1 week after surgery and the last follow-up(P>0.05). VAS score(3.98±0.57 vs. 7.68±0.64) and ODI[(21.82±3.12)% vs. (46.51±4.79)%] at the last follow-up were significantly improved than preoperative ones(P<0.05). Conclusions: The CBCT mosaic imaging combined with I-shaped measurement instrument can be an effective and powerful tool to assess the coronal balance intraoperatively, which can assist spinal surgeons to assess the coronal balance conditions during the corrective surgery for scoliosis in AIS patients, and to timely adjust the correction degree and therefore effectively reduce the incidence of postoperative coronal imbalance.