青少年特发性脊柱侧凸前路矫形策略回顾分析  

Surgical strategy of lowest instrumented vertebrae selection of anterior correction for adolescent idiopathic scoliosis

作　　者：刘洋[1] 李明[2] 朱晓东[2] 施鹏[3] 陈华江[1] 王新伟[1] 袁文[1] 

机构地区：[1]上海长征医院骨科,200003 [2]上海长海医院骨科 [3]第二军医大学统计学教研室

出　　处：《中国矫形外科杂志》2007年第15期1121-1125,共5页Orthopedic Journal of China

基　　金：国家自然科学基金(NO30571888)

摘　　要：[目的]分析青少年特发性脊柱侧凸前路矫形中末端融合椎（LIV）的选择策略,并探讨末端融合椎与躯干平衡的关系。[方法]对获得完整随访资料的28例青少年特发性胸腰椎/腰椎侧凸患者（Lenke 5型）进行回顾性研究,这些患者均接受前路硬棒系统矫形手术,平均随访1.5年（1~3年）,统计分析LIV与融合椎体节段数、椎间盘楔形变、LIV倾斜度、躯干平衡指标等影像学资料之间的关系,分析椎间盘楔形变与躯干平衡之间的关系。[结果]术前末端椎椎间盘角度（2.96°±1.43°）,术后（-3.60°±1.75°）,术后椎间盘楔形变程度与LIV倾斜度关系最为密切（P〈0.01）,躯干总体平衡与LIV-CSVL（骶中线）、融合节段数及LIV倾斜显著相关。[结论]LIV的选择与多个影像学指标相关,对于下端椎与上一椎体椎间盘角度较大,该椎体与顶椎之间椎体少,距离CSVL较远,倾斜角度较大的患者,不适于选择短节段融合。若手术未融合平行的椎间盘,则术后椎间盘楔形变发生的几率较高。[ Objective] To investigate surgical strategy of lowest instrumented vertebrae （LIV） selection of anterior correction for adolescent idiopathic scoliosis, and to discuss correlation of lowest instrumented vertebrae and trunk balance. [ Method] Twenty- eight patients with thoracolumbar/lumbar adolescent idiopathic scoliosis （Lenke 5 type） were treated by anterior correction and fusion with mean 1.5 - year follow - up. Specific radiographic parameters such as LIV and fusion levels, disc wedging, LIV obliquity, global coronal balance were observed respectively, and correlation of disc wedging and these parameters was analyzed. [ Result ] The preoperative disc angle was （ 2. 96°±1.43° ） and postoperative was （ - 3.60°± 1.75° ）. The postoperative disc wedging was most correlated with LIV obliquity. Trunk balance and LIV - CSVL distance, fusion segments, LIV obliquity were significant correlated. [ Conclusion ] Selection of LIV was correlated with various radiographic parameters. Short fusion was inappropriate in such conditions ： big disc angle of lower end vertebrae between superior vertebrae, fewer vertebra between certain vertebrae and apex vertebrae, long distance from certain vertebrae to CSVL and lager obliquity of the vertebrae. Disc wedging distal to LIV tent to occur postoperatively if parallel disc was not involved.

关 键 词：青少年特发性脊柱侧凸 前路脊柱融合 椎间盘楔形变 末端融合椎 

分 类 号：R682.3[医药卫生—骨科学]