单纯凸侧去旋转与凸凹双侧同时去旋转对Lenke 5型AIS的矫形效果比较  

Comparison of surgical outcomes between simple convex-side derotation and bilateral derotation for Lenke 5 adolescent idiopathic scoliosis

作　　者：肖斌[1] 阎凯[1] 张延斌 行勇刚[1] 何达[1] 刘波[1] 田伟[1] XIAO Bin;YAN Kai;ZHANG Yanbin;XING Yonggang;HE Da;LIU Bo;TIAN Wei(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院脊柱外科,北京100035

出　　处：《山东医药》2023年第13期1-5,共5页Shandong Medical Journal

基　　金：中国工程院战略研究与咨询项目(2022-XY-42);吴阶平医学基金会临床科研专项资助项目(320.6750.2021-20-2)。

摘　　要：目的比较单纯凸侧去旋转与凸凹双侧同时去旋转对Lenke 5型青少年特发性脊柱侧凸(AIS)的矫形效果。方法选择Lenke 5型AIS患者52例,其中采取单纯凸侧去旋转矫形固定融合术28例(单侧组)、采取凸凹双侧同时去旋转矫形固定融合术24例(双侧组),比较两组手术相关指标(手术时间、术中出血量、融合节段数量),影像学测量指标(冠状位、矢状位、轴位影像学指标和融合节段邻近椎间盘角度及腰骶影像学指标),脊柱侧凸学会-22r(SRS-22r)评分(包括疼痛、功能状况、自我形象、心理状况、对治疗的满意度五个维度)及手术相关并发症。结果两组手术时间、术中出血量、融合节段数量比较差异均无统计学意义(P均>0.05)。在影像学测量指标中,两组术前及术后矢状位、冠状位、轴位相关影像学指标及上下固定椎邻近椎间盘角度比较差异均无统计学意义(P均>0.05)。双侧组术前与末次随访时矢状位、冠状位上固定椎近端椎间盘角度变化值较大。两组治疗前后SRS-22r各维度评分比较差异均无统计学意义(P均>0.05)。两组术中均无电生理监测异常及手术相关并发症发生。结论单纯凸侧去旋转与凸凹双侧同时去旋转对Lenke 5型AIS的矫形效果相当,顶椎去旋转效果相似。单纯凸侧去旋转可避免凹侧螺钉切割等并发症发生,若行凸凹双侧同时去旋转术后随访时需密切观察融合节段近端椎间盘退变情况。Objective To compare the surgical outcomes of simple convex-side derotation and bilateral derotation for Lenke 5 adolescent idiopathic scoliosis(AIS).Methods Fifty-two Lenke 5 AIS patients were enrolled.Based on vertebral derotation strategies,28 cases were assigned to simple convex-side derotation(unilateral group),and 24 cases were assigned to bilateral derotation(bilateral group).The surgical details including operation time,estimated blood loss,and fusion levels were compared,so did the radiographic parameters including coronal,sagittal,axial parameters,adjacent disc angles and lumbosacral parameters.Scoliosis Research Society(SRS)-22r scores(function,pain,self-image,psychological status,and satisfaction with treatment)and surgical complications were rated.Results There was no significant difference in the operation time,estimated blood loss or fusion levels between two groups(all P>0.05).No significant difference was found in the sagittal,coronal,axial radiographic parameters or adjacent disc angles before surgery and at the last follow-up between two groups.The variations of sagittal and coronal Upper Instrumented Vertebra(UIV)disc angle from pre-operation to last follow-up were greater in the bilateral group.There was no significant difference in SRS-22r scores between two groups(all P>0.05).No deficits were noted in intraoperative neurophysiological monitoring,and no surgical complications were found.Conclusions The surgical outcomes of simple convex-side derotation and bilateral derotation were comparable for Lenke 5 AIS,so was the derotational results.Displacements of the concave screws could be avoided in simple convex-side derotation.If bilateral derotation was performed,attention should be paid to the disc above the UIV in case of degeneration.

关 键 词：青少年特发性脊柱侧凸 直接椎体去旋转 矫形 生活质量 

分 类 号：R687[医药卫生—骨科学]