Lenke 1、2型青少年特发性脊柱侧凸远端附加现象危险因素分析  

Analysis of Risk Factors for Distal Adding-on Phenomenon in Lenke 1,2 Adolescent Idiopathic Scoliosis

作　　者：范嘉旺 郭伟 杨万忠 李嘉鑫 郑任春 戈朝晖[2] FAN Jiawang;GUO Wei;YANG Wanzhong;LI Jiaxin;ZHENG Renchun;GE Zhaohui(Ningxia Medical University,Yinchuan 750004,China;Department of Orthopedic,General Hospital of Ningxia Medical University,First Clinical Medical College of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学,银川750004 [2]宁夏医科大学总医院骨科,宁夏医科大学第一临床医学院,银川750004

出　　处：《宁夏医科大学学报》2024年第5期496-502,506,共8页Journal of Ningxia Medical University

基　　金：宁夏回族自治区重点研发计划项目(2023BEG02017);宁夏医科大学总医院医工专项项目(NYZYYG-005)。

摘　　要：目的探讨不同最下固定椎(LIV)的选择对Lenke 1、2型青少年特发性脊柱侧凸(AIS)的疗效,进一步分析影响术后远端附加现象(AO)发生的危险因素。方法回顾性分析2015年1月至2021年1月行脊柱矫形手术治疗的Lenke 1、2型共94例患者的病历资料。根据LIV与稳定椎(SV)的相对位置关系将患者分为3组:SV<-1组、SV-1组、SV≥0组。所有患者均在术前、术后即刻及末次随访时拍摄站立位全脊柱正侧位X线片,测量手术前后各影像学参数。根据末次随访时是否发生AO分为远端附加组和非远端附加组两组,采用逐步Logistic回归分析进一步探讨影响远端AO的危险因素。结果94例AIS患者随访24~48个月,平均(30.40±5.59)个月,末次随访时13例(13.8%)患者发生远端AO,8例(44.4%)SV<-1、3例(10.7%)SV-1、2例(4.2%)SV≥0。单因素分析显示,两组间术前LIV+1偏移CSVL距离、术后主胸弯顶椎偏距、术后躯干偏移、术后主胸弯Cobb角、术后及末次随访主胸弯Cobb角矫正率、末次随访腰弯Cobb角及其矫正率、末次随访影像学肩高度、Risser征、LIV-SV节段差距差异均有统计学意义(P均<0.05)。将差异有统计学意义的变量纳入Logistic回归分析,术前LIV+1偏移CSVL距离、Risser征(0~2级)及LIV-SV节段差距(LIV-SV<-1)是术后远端AO发生的影响因素(P均<0.05)。结论术前LIV+1偏移CSVL距离、Risser征及LIV-SV节段差距是影响Lenke 1、2型AIS矫形术后远端AO发生的危险因素,LIV选择至少在稳定椎近端一个椎体(SV-1)可防止远端AO的发生。Objective To investigate the efficacy of different lower instrumented vertebra(LIV)choices in the treatment of Lenke 1 and 2 adolescent idiopathic scoliosis(AIS),and to further analyze the risk factors affecting the occurrence of postoperative distal adding-on phenomenon(AO).Methods The medical records of a total of 94 patients with Lenke types 1 and 2 who underwent orthopedic spine surgery from January 2015 to January 2021 were retrospectively analyzed.According to the relative position of LIV and SV,patients were categorized into three groups,SV<-1,SV-1,and SV≥0.All patients had standing posteroanterior and lateral radiographs preoperatively,immediately after surgery,and at the final follow-up,and each imaging parameter was measured before and after surgery.The patients were divided into two groups according to the occurrence of the distal AO at the final follow-up,and the risk factors for its occurrence were further analyzed.Results 94 patients with AIS were followed up for(30.40±5.59)months(24-48 months),and distal AO occurred in 13 patients(13.8%)at the last follow-up:8 SV<-1(44.4%),3 SV-1(10.7%)and 2 SV≥0(4.2%).Factors that showed statistically significant differences between the two groups by univariate analysis included preoperative LIV+1 offset CSVL distance,postoperative parietal offset distance,main thoracic kyphosis Cobb angle correction rate in the immediate postoperative period and at the final follow-up,lumbar kyphosis Cobb angle correction rate at the final follow-up,Risser’s sign,and LIV-SV segmental gap(P all<0.05).Variables with statistically significant differences were analyzed by Logistic regression,and the differences in preoperative LIV+1 offset CSVL distance,Risser’s sign(grade 0-2),and LIV-SV segmental gap(LIV-SV<-1)were statistically significant(P all<0.05).Conclusion Preoperative LIV+1 offset CSVL distance,Risser’s sign,and LIV-SV segmental gap were independent risk factors influencing the occurrence of distal AO.LIV selection at least one vertebra proximal to the stabilized

关 键 词：青少年特发性脊柱侧凸 Lenke 1、2型 最下固定椎 远端附加现象 

分 类 号：R726.8[医药卫生—儿科]