青少年特发性脊柱侧凸术后远端叠加现象的自然史研究  

The natural evolution of postoperative distal adding-on in adolescent idiopathic scoliosis

作　　者：秦晓东[1] 夏超 薛冰川 徐磊磊[1] 邱勇[1] 朱泽章[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》2018年第4期220-227,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金面上项目（81171672）;江苏省临床医学中心（YXZXA2016009）

摘　　要：目的 探讨Lenke 1A和2A型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis, AIS）患者术后远端叠加现象的自然史及其进展的危险因素。方法 回顾性分析2006年7月至2012年7月接受后路选择性胸椎融合手术治疗的Lenke 1A型和2A型患者197例, 其中44例（22.3%）患者术后发生远端叠加现象,男5例,女39例;年龄10-18岁,平均（15.0±2.1）岁;主胸弯Cobb角40°~69°,平均49.3°±9.3°。在初次发生远端叠加现象时与末次随访时的X线片测量远端融合椎（lowest instrumented vertebra,LIV）下位椎间盘成角、LIV下位椎体偏移骶骨正中线距离。根据随访过程中的变化将远端叠加现象分为进展型和非进展型,进展型定义为椎间盘成角进一步增加〉5°或椎体偏移进一步增加〉5 mm,反之则为非进展型。采用独立样本t检验、χ2检验或Fisher精确检验比较进展组与非进展组术前与术后的各临床资料与影像学参数,选取有统计学意义的因素进一步行Logistic回归分析远端叠加现象进展的独立危险因素。结果 44例发生远端叠加现象的患者中进展组17例（38.6%）,非进展组27例（61.4%）。进展组Risser征明显低于非进展组（t=4.399,P〈 0.001）;进展组47.1%的患者LIV位于充分稳定椎 （substantially stable vertebra,SSV）的近端,非进展组3.7%的患者LIV位于SSV的近端,两组差异有统计学意义（Fisher精确检验值=18.142,P〈 0.001）;在随访期间进展组的双肩不平衡改善明显大于非进展组（t=3.011,P=0.002）。Logistic回归分析结果显示术前低Risser征（OR=3.021,P〈 0.001）及LIV位于SSV近端（OR=10.352,P〈 0.001）是远端叠加现象进展的独立危险因素。此外,末次随访时进展组SRS-22评分中自我形象评分明显低于非进展组（t=2.321,P=0.014）。结论 根据远端叠加现象的自然史将其分为进展型和非进展型,其中进展型接近40%。远端叠加现象进展的危险因素包括骨龄不成Objective To investigate the natural evolution of postoperative distal adding-on in Lenke 1A and 2A adolescent idiopathic scoliosis （AIS） patients, and to explore the risk factors for the progression of distal adding-on. Methods From July 2006 to July 2012, a total of 197 AIS patients with Lenke 1A or 2A curves underwent posterior selective thoracic instrumentation and fusion surgery. Among which, 44 patients （22.3%） with postoperative distal adding-on were recruited in this study. There were 39 female and 5 male, with an average age of （15.0±2.1） years. The mean Cobb angle of main thoracic curve was 49.3°±9.3°. The first postoperative radiograph indicating distal adding-on and the last follow-up radiograph were compared： make the measurement of the disc angle below lowest instrumented vertebra（LIV）, and the distance between the vertebra below LIV（LIV＋1） and central sacral vertical line（CSVL）. Distal adding-on could be classified into progressive group and non-progressive group according to its natural evolution during follow-up. If the disc angle increased 〉 5° or the LIV＋1-CSVL distance increased 〉 5 mm,the patients were assigned into progressive group; Otherwise, the patients were assigned into non-progressive group. Using Student T test, χ2 test or Fisher exact test, the predicted risk factors for progression were screened for further Logistic regression. Results Among the 44 patients enrolled in the study, 17 patients （38.6%） had progressive adding-on while 27 patients （61.4%） had non-progressive adding-on. The Risser sign was significantly lower in progressive group than non-progressive group（t=4.399,P〈0.001）. Besides, more patients had LIV proximal to substantially stable vertebra （SSV） in progressive group than non-progressive group（Fisher exact test value=18.142,P〈0.001）. The improvement of shoulder imbalance was significantly better in progressive group than non-progressive group（t=3.011, P=0.002）. According to Logistic regression, the

关 键 词：脊柱侧凸 青少年 脊柱融合术 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]