检索历史 清除

目的 分析Lenke 5C型青少年特发性脊柱侧凸(AIS)患者行选择性前路或后路手术后未融合胸弯自发性矫正的长期疗效及影响因素.方法 将2005年1月至2011年12月89例在南京鼓楼医院骨科接受选择性胸腰/腰弯矫形手术治疗且随访5年以上的Lenke 5C型AIS患者纳入本研究,其中行前路手术43例,后路手术46例.术前、术后即刻及末次随访时测量两组患者胸弯Cobb角、胸腰/腰弯Cobb角、躯干偏移、胸弯顶椎偏距、上端固定椎倾斜、胸椎后凸角、近端交界性后凸角、矢状面整体平衡等影像学参数并进行比较分析,同时分析两组影响胸弯自发矫正的因素.组间数据比较采用独立样本t检验.结果 前路组平均融合节段小于后路组[(5.4±0.6)个比(5.9±0.8)个,t=3.318,P=0.001],手术时间长于后路组[(276±28)min比(186±36)min,t=13.101,P<0.001].术后即刻畸形得到显著矫正,其中两组胸弯自发矫正率分别为50％±21％和56％±20％,差异无统计学意义(t=1.489,P=0.140).两组平均随访(6.8±1.7)年和(6.3±1.3)年.末次随访时胸弯自发矫正率分别为46％±22％和49％±19％(t=0.703,P=0.484),无明显矫正丢失.其他影像学参数同样维持稳定.两组末次随访时代偿胸弯自发矫正率均与上端固定椎(UIV)倾斜呈显著负相关(前路组:r=-0.526,后路组r=-0.399,均P<0.05),与其他因素无显著相关.结论 选择性前路或后路手术治疗Lenke 5C型AIS代偿胸弯自发矫正长期随访效果满意,且手术入路对于自发矫正无影响,UIV倾斜是影响胸弯自发矫正的重要因素.

Objective To analyze the long-term results and the influence factors of spontaneous correction of unfused thoracic curves in anterior and posterior selective fusions in Lenke type 5C adolescent idiopathic scoliosis ( AIS) .Methods From January 2005 to December 2011, 89 Lenke type 5C AIS patients with a minimum of 5-year follow-up who underwent thoracolumbar/lumbar ( TL/L) selective fusion in Spine Surgery of Nanjing Drum Tower Hospital were reviewed .Forty-six patients underwent anterior fusion ( anterior group ) , while 46 underwent posterior fusion ( posterior group ) . The following radiological parameters were measured and analyzed at pre-operation, post-operation, and latest follow-up: curve magnitude of primary thoracolumbar/lumbar and secondary thoracic curve , trunk shift, thoracic apical vertebral translation , upper instrumented vertebra tilt , thoracic kyphosis , proximal junctional angle , sagittal vertical axis.Independent sample t test was used to compare the above parameters between the two groups . Results Compared with those in posterior group , anterior group were found with less fusion levels ( 5.4 ± 0.6 vs 5.9 ±0.8, t=3.318, P=0.001) and longer operation time[(276 ±28)min vs (186 ±36)min,&nbsp;t=13.101, P<0.001].Immediately after surgery, the spinal deformity was significantly corrected in the two groups.The mean spontaneous correction rates of the minor curve were 50％±21％and 56％±20％in anterior and posterior groups, respectively (t=1.489, P=0.140).After a mean follow-up of (6.8 ±1.7) years in anterior group and (6.3 ±1.3) years in posterior group, the spontaneous correction rate of minor curve was maintained at 46％ ±22％ and 49％ ±19％, respectively (t=0.703, P=0.484), with no significant correction loss.Other radiographic parameters were also stably maintained .According to the correlation analysis , the spontaneous correction rate was significantly correlated with upper instrumented vertebra (UIV) tilt in both groups (anterior: r=-0.526, posterior: r=-0.399, both P<0.05). Conclusions Both anterior and posterior selective fusion can achieve satisfactory spontaneous correction of unfused thoracic curves in Lenke type 5C AIS, with no significant difference between the two surgical approaches.UIV tilt is a key influence factor of spontaneous correction of thoracic curves .