不同Risser征的Lenke 1型青少年特发性脊柱侧凸前路矫形术后远期胸椎后凸重建  

Reconstruction of Thoracic Kyphosis Following Anterior Corrective Surgery in Lenke 1 Adolescent Idiopathic Scoliosis Patients with Different Risser Signs at Long Term Follow-up

作　　者：田振 李劼 刘昌伟 徐辉 胡宗杉 刘臻 朱泽章[2] 邱勇[2] TIAN Zhen;LI Jie;LIU Chang-wei;XU Hui;HU Zong-shan;LIU Zhen;ZHU Ze-zhang;QIU Yong(Drum Tower School of Clinical Medicine,Nanjing University of Traditional Chinese Medicine,Nanjing 210008,China;Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京中医药大学鼓楼临床医学院,南京210008 [2]南京大学医学院附属鼓楼医院骨科脊柱外科,南京210008

出　　处：《骨科》2023年第1期34-39,共6页ORTHOPAEDICS

基　　金：国家自然科学基金(82072518);南京市医学科技发展项目(ZKX22017)。

摘　　要：目的探讨不同Risser征的Lenke 1型青少年特发性脊柱侧凸(adolescence idiopathic scoliosis,AIS)前路矫形术后远期胸椎后凸角(TK)变化的差异。方法回顾性分析2002年6月至2007年7月在我院接受前路矫形术治疗的40例Lenke 1型AIS病人的临床资料,病人年龄为(14.1±1.7)岁,其中男3例,女37例。根据病人Risser征评分将其分为三组:A组(Risser 0)、B组(Risser 1~3)和C组(Risser 4~5)。分别测量每例病人术前、术后即刻、术后第2年随访及末次随访时的正侧位X线片上的以下参数:胸主弯和代偿腰弯的冠状面Cobb角、TK(T_(5)~T_(12))、前椎体高度(VBHa)、后椎体高度(VBHp)、椎弓根高度(PH)以及椎弓根间高度(IPH),并计算T_(5)~T_(12)的前椎体高度总和(SVBHa)、后椎体高度总和(SVBHp)、椎弓根高度总和(SPH)、椎弓根间高度总和(SIPH)、SVBHp/SVBHa和(SIPH+SPH)/SVBHa。结果术后对三组病人进行了长达5~13年(平均6.5年)的随访。相较于术后即刻测量的TK,末次随访时A组的TK平均值显著增加(增加13.7°),但B组和C组两次随访时的平均TK值未见明显增大。40例病人中有11例(27.5%)末次随访时的TK值较术后即刻显著增大,其中6例(85.7%)来自A组,这一比例显著高于B组(21.4%)和C组(10.5%)。末次随访时,40例病人的平均SVBHp、SPH+SIPH、SVBHp/SVBHa以及(SIPH+SPH)/SVBHa均显著高于术后即刻,差异有统计学意义(P<0.05);其中A组的平均SVBHp/SVBHa、(SIPH+SPH)/SVBHa在末次随访时较术后即刻显著增加,差异有统计学意义(P<0.05);而B、C两组均未见显著差异。结论Lenke 1型AIS前路选择性融合术后远期有27.5%的病人发生了显著的胸椎后凸重建,这可能与低Risser征病人脊柱后份持续生长相关。Objective To investigate the long-term changes of thoracic kyphosis(TK)following anterior corrective surgery in Lenke 1 adolescent idiopathic scoliosis(AIS)patients with different Riser signs.Methods We retrospectively reviewed 40 AIS patients(Lenke 1)who received anterior selective fusion in our institution from June 2002 to July 2007.The patients were(14.1±1.7)years old,including 3 males,37 females.The patients were divided into three groups according to the preoperative Risser signs:group A(Risser 0),group B(Risser 1-3)and group C(Risser 4-5).The following parameters were measured on the posterior-anterior and lateral X-ray films before the operation,immediate post-operation,2-year follow-up and the final follow-up:coronal Cobb angles of main thoracic curve and compensatory lumbar curve,TK(T_(5)~T_(12)),anterior vertebral body height(VBHa),posterior vertebral body height(VBHp),pedicle height(PH),inter pedicle height(IPH).The sum of anterior vertebral body height(SVBHa),posterior vertebral body height(SVBHp),pedicle height(SPH),inter pedicle height(SIPH),SVBHp/SVBHa,(SIPH+SPH)/SVBHa of T_(5)~T_(12)were calculated.Results Patients in all three groups were followed up for 5 to 13 years(mean 6.5 years).Compared with the TK measured immediately after operation,TK was significantly increased(13.7°)at the final follow-up in group A.But no significant increase was observed at 2-year follow-up and the final follow-up in group B and group C.At the last follow-up,the TK of 11 cases(27.5%)was significantly improved compared with that immediately after operation,including 6 cases(85.7%)in group A.The incidence of significant TK increase was obviously higher in group A than group B(21.4%)and group C(10.5%).The SVBHp,SPH+SIPH,SVBHp/SVBHa and(SIPH+SPH)/SVBHa of 40 patients were significantly higher than those immediately after operation at the final followup,with statistically significant(P<0.05).The SVBHp/SVBHa and(SIPH+SPH)/SVBHa in group A were significantly increased at the final follow-up compared with those immediatel

关 键 词：青少年特发性脊柱侧凸 前路手术 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]