生长棒手术治疗早发性脊柱侧凸对颈椎矢状面序列的影响  

Change of cervical sagittal alignment after the treatment of growing rods to the early-onset scoliosis

作　　者：韩渤 潘爱星 海涌[1] 张天擎 刘玉增[1] 关立[1] Han Bo;Pan Aixing;Hai Yong;Zhang Tianqing;Liu Yuzeng;Guan Li(Department of Orthopedics,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《中华医学杂志》2020年第13期983-990,共8页National Medical Journal of China

基　　金：国家自然科学基金(81372008)。

摘　　要：目的通过对早发性脊柱侧凸(EOS)患者在生长棒治疗期间颈椎矢状面参数分析,探讨生长棒手术对颈椎矢状面序列的影响。方法回顾性连续纳入2009至2018年在北京朝阳医院骨科接受生长棒手术治疗且影像学资料完整的24例EOS患者临床资料,其中男17例,女7例,使用Surgimap软件对生长棒置入术前及术后、生长棒调节术前及术后的脊柱全长正侧位X线(包括中立位颈椎侧位片)进行测量,其中颈椎矢状位参数包括颈椎前凸C2-7Cobb角、T1倾斜角、C2-7颈椎矢状位平衡(C2-7SVA);对脊柱全长影像学参数胸弯/胸腰弯Cobb角、T5-12 Cobb角即胸椎后凸角(TK)、最大后凸Cobb角、C7-S1脊柱矢状位平衡(SVA)及近端交界区角度(PJA)等进行测量;对术前、术后及末次随访影像学参数进行统计学分析;同时记录患者手术情况,包括上端固定椎(UIV)、有无节段近端交界性后凸(PJK)、单侧/双侧生长棒,分别进行组间对比分析;使用Logistic二元多因素回归分析颈椎矢状面失平衡的危险因素。结果本研究纳入的24例EOS患者,所有患者均经1次以上撑开手术,随访时间(35±14)个月。患者术前C2-7Cobb角为17°±11°,T1倾斜角为28°±13°,C2-7SVA为(17±11)mm,术后分别为18°±9°、28°±11°、(16±10)mm,手术前后差异均无统计学意义(t=-1.15、0.14、0.55,均P>0.05)。末次调棒随访时C2-7Cobb角、T1倾斜角、C2-7SVA均较术前明显增大,差异均有统计学意义(t=-7.60、-4.08、-2.46,均P<0.05)。PJK组△C2-7Cobb角、△T1倾斜角均较非PJK组更显著,差异有统计学意义(t=3.50、3.25,均P<0.05);而UIV选择和生长棒数量对于△C2-7Cobb角、△T1倾斜角无显著影响(t=-1.02、-1.61、-0.67、0.31,均P>0.05)。Logistic二元多因素回归分析,发现PJK的出现为发生颈椎矢状位失平衡的独立危险因素(OR=11.57,95%CI:1.49~91.54,P<0.05)。结论生长棒手术在矫正脊柱侧凸的同时,生长棒手术会增加EOS患者的颈椎前凸及T1Objective To determine the impact of growing rods(GR)technique on cervical alignment in early-onset scoliosis(EOS)through the change of cervical alignment parameters after the GR surgery.Methods Total of 24 consecutive EOS patients treated in Beijing Chao-Yang Hospital from 2009 to 2018 were retrospectively reviewed(17 males and 7 females).Cervical lordosis,T1 slope and C2-7 sagittal vertical axis(C2-7SVA),thoracic/lumbar Cobb angle,thoracic kyphosis(TK),global kyphosis Cobb angle,SVA were included in radiographic data in the full spinal standing X-ray before and post operation and at the last follow-up.Based on clinical data,including the upper instrumented vertebra(UIV),proximal junctional kyphosis(PJK)and the number of GR,patients were divided into different groups for statistical analysis.Logistic regression analysis was used to find the independent risk factors of the abnormality of C2-7SVA.Results All patients received at least one time of distraction operation,the mean follow-up was(35±14)months.The C2-7 Cobb angle increased from 17°±11°to 18°±9°and T1 slope changed from 28°±13°to 28°±11°and C2-7SVA changed from(17±11)mm to(16±10)mm after the operation,but no significant differences were found in those indexes before and after the operation(t=-1.15,0.14,0.55,all P>0.05).At the last follow-up after GR technique,the C2-7 Cobb angle,T1 slope angle and C2-7SVA significantly increased when compared with those before the operation(t=-7.60,-4.08,-2.46,all P<0.05).The△C2-7 Cobb angle and△T1 slope angle PJK group was both more significant than those in non-PJK group(t=3.50,3.25,both P<0.05);while there was no significant difference in the△C2-7 Cobb angle and△T1 slope angle when the choice of UIV and the number of GD were taken into account(t=-1.02,-1.61,-0.67,0.31,all P>0.05).The occurrence of PJK was identified as an independent risk factor for the abnormality of C2-7SVA during the GR surgery with logistic regression analysis(OR=11.57,95%CI:1.49-91.54,P<0.05).Conclusions When used for EOS to

关 键 词：早发性脊柱侧凸 生长棒技术 颈椎矢状位 近端交界性后凸 

分 类 号：R687[医药卫生—骨科学]