青少年特发性胸椎侧凸选择性融合术后的远端交界性后凸  

Study of distal junctional kyphosis of adolescent idiopathic scoliosis following anterior or posterior selective instrumented fusion and its risk factors

作　　者：邱勇[1] 夏才伟[1] 王斌[1] 俞杨[1] 朱泽章[1] 钱邦平[1] 朱锋[1] 马薇薇[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华骨科杂志》2009年第2期117-122,共6页Chinese Journal of Orthopaedics

基　　金：江苏省南京市卫生局重点项目（ZKX05016）

摘　　要：目的 探讨青少年特发性脊柱侧凸患者选择性胸弯内固定融合术后远端交界性后凸（distal junctional kyphosis，DJK）的危险因素。方法行选择性前路或后路胸弯内固定融合术的青少年特发性脊柱侧凸患者59例，女50例，男9例。前路胸腔镜8例、小切口19例，后路远端钩19例、远端钉13例。于术后3个月、6个月、1年、2年摄站立位全脊柱正侧位X线片，测量术前及术后末次随访时主弯Cobb角、次弯Cobb角、固定节段数、矢状面T5～T12后凸、T10～L2后凸、L1～S1前凸及DJK。结果术后随访12～36个月，平均17个月。与术前相比，末次随访时前路两组T5～T12后凸明显增大，T10～L2和远端交界区出现前凸减小、后凸增大的趋势。后路远端钩组T5～T12后凸、T10～L2后凸、交界区后凸均增大，L1～S1前凸出现姿势代偿性增大。远端钉组矢状面变化不明显，远端钩组术后出现T10～L2后凸增大的可能性及DJK阳性率均高于远端钉组。前路患者，无论术后DJK是否正常，其矢状面T5～T12后凸均较术前增大，术前T5～L2前凸在术后均转变为后凸。后路患者，DJK阳性患者的T5～T12及T5～L2后凸较术前增大，L1～S1前凸代偿性增大；DJK阴性患者的矢状面形态与术前比较变化不大。后路术后DJK阳性组T10～L2后凸大于DJK阴性组。结论胸腔镜及小切口两组DJK阳性率接近，远端矢状面失代偿的危险因素是融合节段过短；后路术后远端钩组DJK阳性率大于远端钉组，矢状面失代偿与远端椎板钩固定不稳定有关。Objective To compare the sagittal measurements before and after surgery in patients with adolescent idiopathic scoliosis （AIS） treated with instrumented fusion, and determine the incidence of distal junctional kyphosis （DJK） and its risk factors. Methods Fifty-nine patients with Lenke 1 type AIS underwent anterior or posterior instrumented fusion. In anterior group, including thoracoscopic surgery in 8 cases and mini-open surgery in 19 cases, while in posterior group, including 13 cases with distal pedicle screw fixation and 19 cases with hook constructs. The standing long-cassette anteroposterior and lateral radiographs of spine were taken, and the coronal and sagittal parameters were measured before and after surgery and during follow-up. Results At recent follow-up, the T5～T12, T10～L2 sagittal measurement and DJK of anterior group increased significantly versus preoperation, the T5～T12 kyphosis, T10～L2 kyphosis, DJK and L1-Sl lordosis of posterior hook group increased significantly versus preoperation. The postoperative mean T10-L2 kyphosis and DJK in the posterior hook group were 13.1° and 8.7° compared to 0.1° and -2.2° in the posterior distal pedicle screw group. When postoperative DJK developed in the posterior group, mean postoperative T5-T12 kyphosis, T10-L2 kyphosis and Li-S1 lordosis 18.5°, 13.6° and 51.1° versus 11.6°, 0.5° and 42.2° preoperatively. When postoperative DJK developed in the posterior group, mean postoperative T10～L2 was 13.6° kyphosis compared to 2.6° in the posterior group without DJK. Conclusion The AIS patients undergoing selective anterior fusion may develop sagittal decompensation in distal junctional segments without instrumentation for its risk factor of short fusion segments. The A1S patients undergoing selective posterior hook instrumented fusion may develop sagittal decompensation for its risk factor of instability.

关 键 词：脊柱侧凸 青少年 脊柱融合术 脊柱后凸 

分 类 号：R686[医药卫生—骨科学]