后路双棒同步异质性去旋转矫治Lenke 1A和2A型青少年特发性脊柱侧凸的下端融合策略及疗效分析  

Selection of Lowest Instrumented Vertebrae and Therapeutic Effect Evaluation in the Treatment of Lenke Type 1A and 2A Adolescent Idiopathic Scoliosis with Posterior Simultaneous Heterogeneous Derotation by Bilateral Corrective Rod

作　　者：徐涛[1] 方煌 王欢[1] 陈栎昀 丁一帆 许浩然 汪波[1] XU Tao;FANG Huang;WANG Huan;CHEN Li-yun;DING Yi-fan;XU Hao-ran;WANG Bo(Department of Orthopaedics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院骨科,武汉430030

出　　处：《骨科》2023年第2期105-110,共6页ORTHOPAEDICS

摘　　要：目的探讨后路双棒异质性去旋转技术在Lenke 1A和2A型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)矫治中的临床疗效和远端融合策略。方法回顾分析我院55例接受后路双棒异质性去旋转矫治的Lenke 1A和2A型AIS病人,所有病人随访1年以上。所有病人在手术前后及末次随访时均拍摄全脊柱正侧位片,测量侧凸Cobb角、顶椎偏距、冠状位平衡、矢状位平衡等参数。分析末次随访时远端叠加现象发生的危险因素。结果55例病人的随访时间为(48.8±24.8)个月。术前主胸弯Cobb角为50.8°±10.4°,术后矫正至8.2°±4.9°,末次随访时为9.1°±4.9°,矫正率为82.3%±9.2%;术前腰弯Cobb角为28.5°±7.0°,术后矫正至5.1°±3.2°,末次随访时为6.3°±4.1°,矫正率为77.9%±13.6%。末次随访时7例病人出现远端叠加现象,发生率为12.7%。远端融合至最后实质性接触椎(LSTV)-1的病例中,发生远端叠加现象的病人与未发生的病人在手术年龄、Risser征、LSTV与下端椎(LEV)的位置关系方面的差异存在统计学意义(P=0.041,P=0.014,P=0.020)。结论采用后路双棒同步异质性去旋转矫治Lenke 1A和2A型AIS,可以获得满意矫形效果,有助于重建和维持脊柱平衡,减少尾侧融合节段。对于Lenke 1A和2A型AIS病人,若骨骼成熟度正常,LIV可以选择LSTV-1。若骨骼成熟度低,LSTV与LEV相差两个椎体时,可以选择LSTV-1作为LIV。但在LSTV与LEV相差一个或少于一个椎体时,远端叠加现象的风险增加,LIV应选择LSTV。Objective To analyze the outcomes of Lenke type 1A and 2A adolescent idiopathic scoliosis(AIS)curves treated by posterior simultaneous heterogeneous derotation by bilateral corrective rod.Methods A total of 55 patients with Lenke type 1A and 2A curves who underwent posterior bilateral corrective rod simultaneous correction in our institution and had a minimum follow-up of 1 year were retrospectively analyzed.Radiographic measurements were performed on full-spine posteroanterior and lateral digital radiographs preoperatively,immediately after operation,and at the last follow-up.The following parameters were measured:the Cobb angle of main thoracic and lumbar curve,coronal balance and sagittal balance.Factors associated with the incidence of adding-on were analyzed.Results The follow-up time was(48.8±24.8)months.The Cobb angle of the main thoracic curve was 50.8°±10.4°preoperatively,8.2°±4.9°postoperatively,and 9.1°±4.9°at the last follow-up,with the mean correction rate of 82.3%±9.2%.The Cobb angle of lumbar curve was 28.5°±7.0°preoperatively,5.1°±3.2°postoperatively,and 6.3°±4.1°at the last follow-up,with the mean correction rate of 77.9%±13.6%.At the last follow-up,7 patients were identified as having distal adding-on phenomenon,and the incidence of adding-on was 12.7%.In the cases of distal fusion to LSTV-1,there was a statistically significant difference between the patients who had distal adding-on and the patients without it in terms of age at surgery(P=0.041),Risser sign(P=0.014)and the discrepancy between LSTV and LEV(P=0.020).Conclusion The application of posterior bilateral corrective rod simultaneous correction technique can achieve satisfactory results,reestablish spinal balance and reduce fusion segments.LSTV-1 can be selected as LIV in skeletally mature patients.Meanwhile,for patients with skeletally immature,LSTV-1 can be selected as LIV if the discrepancy between LSTV and LEV is two levels.However,when the discrepancy between LSTV and LEV is less than two levels,the risk of add

关 键 词：青少年特发性脊柱侧凸 远端固定椎 远端叠加现象 

分 类 号：R687.3[医药卫生—骨科学]