| 陈 超,王 征,崔 赓,宋 凯,苏晓静,张 恒,齐 鹏.Lenke 5型青少年特发性脊柱侧凸患者后路矫形术后颈椎矢状位曲度的改变[J].中国脊柱脊髓杂志,2019,(5):400-406. |
| Lenke 5型青少年特发性脊柱侧凸患者后路矫形术后颈椎矢状位曲度的改变 |
| 中文关键词: 青少年特发性脊柱侧凸 Lenke 5型 矫形手术 颈椎矢状位曲度 |
| 中文摘要: |
| 【摘要】 目的：分析Lenke 5型青少年特发性脊柱侧凸（AIS）患者颈椎矢状位曲度（CSA）在后路矫形术后改变的特点。方法：回顾性分析2011年7月～2017年7月解放军总医院脊柱外科收治的43例Lenke 5型AIS患者的临床资料。在术前、术后及末次随访时的X线片上测量颈椎前凸角（CL）、胸椎后凸角（TK）、胸腰段后凸角（TLK）、腰椎前凸角（LL）、融合节段内腰椎前凸角（LIF）、C7矢状位垂直距离（SVA）。同时统计患者的基本资料，包括性别、年龄、Risser征、随访时间、融合节段椎体数目（NVF）及术前胸腰段/腰弯（TL/L Curve，TL/L C）。依据患者术前CSA分为颈椎前凸组（L组，术前CL＜0°）、颈椎后凸组（K组，术前CL≥0°）；依据患者末次随访时CSA较术前的改变分为颈椎前凸增加组（I组）与颈椎前凸减少组（D组）。使用t检验分析L组与K组、I组与D组对应参数的差异性，使用LSD-t检验分析各组内术前、术后、末次随访时参数的差异。使用Pearson相关性检验分析CL与I组和D组各参数的相关性。检验水准为双侧α=0.05。结果：43例患者中男10例，女33例；年龄15.90±4.98岁，随访时间22.84±14.10个月。L组15例，K组17例；I组26例，D组17例。L组与K组、I组与D组的基本资料无显著性差异。所有患者末次随访时TK较术前增加（P=0.000）；术后TLK与术前比较有显著性差异（P=0.000）；CL在术前、术后及末次随访时无统计学差异。L组与K组术前CL（P=0.000）、LIF（P=0.029）、SVA（P=0.003）差异有统计学意义（P<0.05）。K组末次随访时CL较术前改善（P=0.025），TK较术前增加（P=0.000）；术后TLK较术前减小（P=0.002）并维持至末次随访（P=0.002）。I组与D组术前LL（P=0.043）、CL（P=0.009）有显著性差异（P<0.05）。I组末次随访时CL较术前改善 （P=0.008），TK较术前（P=0.000）及术后（P=0.001）增加；术后TLK较术前减小（P=0.005）并维持到末次随访时（P=0.006）。D组术后LL较术前增加（P=0.011）并维持到末次随访（P=0.001）。I组术前CL与TK、SVA有相关性；D组CL术前与LL、SVA，术后与TLK、SVA，末次随访时与TLK有相关性。结论：术前颈椎后凸的患者较颈椎前凸的患者在术后CSA的改善更为明显；随访中TK增加、术后TLK改善可能有助于CSA的改善；术后只有LL增加而无TK、TLK的改变则可能不会引起CSA改善。 |
Changes of cervical sagittal alignment after posterior correction surgery in Lenke 5 adolescent idiopathic scoliosis |
| 英文关键词:Adolescent idiopathic scoliosis Lenke 5 Correction surgery Cervical sagittal alignment |
| 英文摘要: |
| 【Abstract】 Objectives: To analyze the changes of cervical sagittal alignment(CSA) in Lenke 5 adolescent idiopathic scoliosis(AIS) after posterior correction surgery. Methods: A total of 43 Lenke 5 adolescent AIS in Spine Department of PLA General Hospital from July 2011 to July 2017 was retrospectively analyzed. Cervical lordosis(CL), thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), lumbar lordosis(LL), lordosis in fusion(LIF) and C7 sagittal vertical axis(SVA) were measured on lateral X-ray at preoperation, postoperation and last follow-up. The general data included gender, age, Risser score, the follow-up time, the number of vertebras in fusion segment(NVF) and TL/L curve(TL/L C). According to the cervical sagittal alignment at preoperation, patients were divided into the lordotic group(L group, pre- CL＜0°) and kyphotic group(K group, pre- CL≥0°). According to the change of cervical sagittal alignment at last follow-up vs preoperation, patients were divided into the lordosis increased group(I group) and the lordosis decreased group(D group). T-test was used to analyze the differences of parameters between L group and K group, I group and D group. LSD-t test was used to analyze the differences of parameters at preoperation, postoperation and last follow-up. Pearson correlation test was used to analyze the correlation between CL and corresponding parameters in I and D group. α=0.05 was difined in the two-sided test. Results: All the 43 patients, 10 males and 33 females, with age of 15.90±4.98 years and follow-up of 22.84±14.10 months, were divided into L group(n=15) & K group(n=17) preoperatively, and into I group(n=26) & D group(n=17) at last follow-up. No statistically significant difference of the general parameters was found between L group and K group, I group and D group. In all patients, the final TK increased when compared to preoperative TK(P=0.000); the postoperative TLK was significantly different from preoperative TLK(P=0.000), and no statistically significant difference was found among preoperative， postoperative and final CL. Subgroup comparisons between L group and K group showed significant differences(P<0.05) of preoperative CL(P=0.000), LIF(P=0.029) and SVA(P=0.003). Intra-group comparisons in group K showed increased CL(P=0.025) and TK(P=0.000) at last follow-up, and smaller postoperative TLK(P=0.002) which continued to last follow-up(P=0.002). Subgroup comparisons between group I and group D showed significant differences(P<0.05) of preoperative LL(P=0.043) and CL(P=0.000). Final CL significantly increased when compared to preoperative CL(P=0.008), and TK significantly increased compared to preoperative(P=0.000) and postoperative TK(P=0.001) in group I. TLK showed smaller at postoperation than at preoperation(P=0.005), which was kept at last follow-up(P=0.006) in I group. LL showed lager at postoperation than at preoperation(P=0.011), which was kept at last follow-up(P=0.001) in D group. There were correlations between CL and TK, CL and SVA preoperatively in group I. CL was also correlated with LL and SVA preoperatively, with TLK and SVA postperatively and with TLK at last follow-up in D group. Conclusions: Patients with kyphotic CSA preoperatively have their CL improved more significantly at last follow-up than that with lordotic CSA preoperatively. Increased TK during follow-up and appropriate TLK postperatively might result in improved CSA finally. Increased LL postperatively without the change of TK or TLK might not result in improved CSA finally. |
| 投稿时间：2019-01-17 修订日期：2019-04-10 |
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