青少年特发性脊柱侧凸选择性融合术中未融合腰弯与未融合胸弯的矫正效果比较  

Comparison of orthopedic effects of unfused lumbar curve and unfused thoracic curve following selective fusion for adolescent idiopathic scoliosis

作　　者：张延斌 肖斌[1] 阎凯[1] 行勇刚[1] 何达[1] 刘波[1] ZHANG Yanbin;XIAO Bin;YAN Kai;XING Yonggang;HE Da;LIU Bo(Department of Spinal 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16期9-12,共4页Shandong Medical Journal

基　　金：吴阶平医学基金会临床科研专项资助基金项目(320.6750.2021-20-2);北京积水潭医院院级科研基金项目(QN-202203)。

摘　　要：目的比较青少年特发性脊柱侧凸(AIS)选择性融合术中未融合腰弯与未融合胸弯的矫正效果。方法选择AIS患者76例,根据手术方式不同分为选择性胸弯融合组42例和选择性腰弯融合组34例。术前、术后即刻及末次随访时拍摄站立位脊柱全长正侧位X线片,测量冠状面参数(包括胸弯Cobb角、胸腰弯或腰弯Cobb角)、矢状面参数(包括胸后凸、胸腰交界、腰前凸),计算未融合弯柔韧性、术后即刻矫正率、最终矫正率、Cobb角变化值,统计末次随访时Cobb角角度丢失、维持、改善例数。结果选择性胸弯融合组术前腰弯Cobb角为28.1°±5.9°,未融合弯柔韧性为(106.88±29.43)%,末次随访时最终矫正率为(65.4±17.1)%;选择性腰弯融合组术前胸弯Cobb角为26.4°±6.9°,未融合弯柔韧性为(72.7±23.0)%,末次随访时最终矫正率为(44.7±26.6)%;两组比较P均<0.05。末次随访时,未融合腰弯Cobb角变化值及角度丢失、角度维持、角度改善占比与未融合胸弯比较差异均无统计学意义(P均>0.05)。结论AIS接受选择性融合术中未融合腰弯的矫正效果优于未融合胸弯,随访期间未融合腰弯与未融合胸弯的行为特征类似,发生角度丢失和角度改善的概率基本一致。Objective To compare the orthopedic effects of unfused lumbar curve and unfused thoracic curve follow⁃ing selective fusion for adolescent idiopathic scoliosis(AIS).Methods Seventy-six patients with AIS were selected and divided into the selective thoracic curve fusion group of 42 patients and selective lumbar curve fusion group of 34 patients according to different surgical methods.Full-length anterolateral radiographs of the standing spine were taken before sur⁃gery,immediately after surgery and at the last follow-up.Coronal Cobb Angle(including thoracic curve Cobb angle,thora⁃columbar curve or lumbar curve Cobb angle)and sagittal plane parameters(including thoracic kyphosis,thoracolumbar junction and lumbar lordosis)were measured.The changes in flexural flexibility without fusion,immediate postoperative correction rate,final correction rate and Cobb angle were calculated.The cases of Cobb angle loss,maintenance and im⁃provement at the last follow-up were counted.Results The Cobb angle of non-structural lumbar curve before selective thoracic curve fusion was 28.1°±5.9°,the flexibility of unfused curve was 106.88%±29.43%,and the final correction rate was 65.4%±17.1%at the last follow-up.The Cobb angle of non-structural thoracic curve before selective lumbar curve fusion was 26.4°±6.9°,the flexibility of unfused curve was 72.7%±23.0%,and the final correction rate was 44.7%±26.6%at the last follow-up.At the last follow-up,there were no significant differences in Cobb angle change,angle loss,angle maintenance or angle improvement ratio between unfused lumbar curve and unfused thoracic curve(all P>0.05).Conclusions When AIS underwent selective fusion,the orthopedic effect of unfused lumbar curve was better than that of unfused thoracic curve.During the follow-up period,the behavior characteristics of unfused lumbar curve and unfused thoracic curve were similar,and the probability of angle loss and angle improvement were basically the same.

关 键 词：青少年特发性脊柱侧凸 选择性胸弯融合 选择性腰弯融合 

分 类 号：R687[医药卫生—骨科学]