Lenke 5C型青少年特发性脊柱侧凸病人行后路脊柱融合术后持续性冠状面失衡的危险因素分析  

Risk Factors and Clinical Impact of Persistent Coronal Imbalance Following Posterior Spinal Fusion in Lenke 5C Adolescent Idiopathic Scoliosis

作　　者：高翔成 都金鹏 黄云飞[2] 王江 李帅 郝定均[2] 闫亮[2] 贺宝荣[2] GAO Xiang-cheng;DU Jin-peng;HUANG Yun-fei;WANG Jiang;LI Shuai;HAO Ding-jun;YAN Liang;HE Bao-rong(Medical School of Yan'an University,Yan'an 716000,China;Department of Spine Surgery,Honghui Hospital Affiliated to Medical College,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]延安大学医学院,陕西延安716000 [2]西安交通大学医学院附属红会医院脊柱外科,西安710054

出　　处：《骨科》2023年第1期19-26,共8页ORTHOPAEDICS

基　　金：陕西省科技计划项目(2018HJCG-08);陕西省中医药管理局项目(2021-02-ZZ-016);西安市科技计划项目(21YXYJ0024)。

摘　　要：目的探讨Lenke 5C型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)病人行后路脊柱融合术后持续性冠状面失衡(persistent coronal imbalance,PCI)的危险因素。方法回顾性分析2015年1月至2020年1月在西安交通大学附属红会医院行后路脊柱融合术且随访2年以上的112例Lenke5C型AIS病人的临床资料。根据病人术后2年的冠状面平衡状态分为PCI组和非PCI组。PCI定义为术后冠状面失衡持续时间≥2年。测量并比较两组病人术前、术后即刻和术后2年的各项冠状面参数和矢状面参数;采用脊柱侧凸研究学会-22评分量表(Scoliosis Research Society-22,SRS-22)评估病人临床疗效。并进一步对上述相关因素进行多元二分类Logistic回归分析确定PCI的独立危险因素。结果112例病人中,50例(44.6%)术后发生即刻冠状面失衡,其中12例(10.7%)冠状面失衡持续至术后2年。多元二分类Logistic回归分析显示,年龄较大[比值比(odds ratio,OR)=1.841,95%可信区间(confidence interval,CI):1.147~2.132,P=0.001]、术前胸弯柔韧性较差(OR=1.308,95%CI:1.041~2.015,P=0.016)、术前胸腰弯/腰弯顶椎偏移较大(OR=2.291,95%CI:1.120~4.719,P=0.001)、术前下端固定椎(lowest instrumented vertebra,LIV)倾斜角较大(OR=2.141,95%CI:1.491~3.651,P=0.011)、术后即刻冠状面失衡(OR=5.512,95%CI:4.531~6.891,P=0.001)是发生PCI的独立危险因素。PCI组术后2年SRS-22量表满意度和总分均显著低于非PCI组(P<0.05)。结论年龄较大、术前胸弯柔韧性较差、术前胸腰弯/腰弯顶椎偏移较大、术前LIV倾斜角较大和术后即刻冠状面失衡是预测PCI的重要参数。PCI对Lenke 5C型AIS病人后路脊柱融合术后临床效果产生不良影响。Objective To investigate the risk factors and clinical effects of persistent coronal imbalance(PCI)following posterior spinal fusion(PSF)in Lenke 5C adolescent idiopathic scoliosis(AIS).Methods The records of 112 patients with Lenke 5C AIS who underwent PSF with a minimum of 2 years of follow-up at Honghui Hospital Affiliated to Xi’an Jiaotong University from January 2015 to January 2020 were retrospectively reviewed.Patients were grouped into PCI group and non-PCI group according to the occurrence of PCI at 2nd year after surgery.PCI was defined as coronal imbalance persisting 2 years after surgery.Coronal and sagittal parameters were measured and compared between the two groups preoperatively,immediately after surgery,and 2 years postoperatively.The Scoliosis Research Society-22(SRS-22)score was used to evaluate clinical outcomes.Multivariate binary Logistic regression analysis was used to determine the independent risk factors for PCI.Results Of the 112 patients,50(44.6%)had immediate postoperative coronal imbalance,and12 of these patients(10.7%)had coronal imbalance persisting 2 years after surgery.Multivariate binary Logistic regression analysis revealed that older age[odds ratio(OR)=1.841,95%confidence interval(CI):1.147-2.132,P=0.001],lower preoperative flexibility main thoracic curve(OR=1.308,95%CI:1.041-2.015,P=0.016),greater preoperative apical vertebral translation of the thoracolumbar/lumbar curve(OR=2.291,95%CI:1.120-4.719,P=0.001),larger preoperative lowest instrumented vertebra(LIV)tilt(OR=2.141,95%CI:1.491-3.651,P=0.011),postoperative immediate coronal imbalance(OR=5.512,95%CI:4.531-6.891,P=0.001)were the risk factors for the occurrence of PCI.The satisfaction and total score of SRS-22 scale in PCI group were significantly lower than those in non-PCI group at 2nd year after surgery(P<0.05).Conclusion Older age,lower preoperative flexibility main thoracic curve,larger preoperative apical vertebral translation of the thoracolumbar/lumbar curve,larger preoperative LIV tilt and postoperative immedia

关 键 词：青少年特发性脊柱侧凸 冠状面失衡 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]