影响重度Lenke 1型青少年特发性脊柱侧凸矫形术后患者肩部失衡的相关因素  

Related factors affecting shoulder imbalance in patients with severe Lenke type 1 adolescent idiopathic scoliosis after orthopedic surgery

作　　者：何小元 陈涛 何贤波 李国军 杨雪健 黄涛[1] 孟志斌[1] 陈焕雄 HE Xiaoyuan;CHEN Tao;HE Xianbo;LI Guojun;YANG Xuejian;HUANG Tao;MENG Zhibin;CHEN Huanxiong(Department of Spine Surgery,The First Affiliated Hospital of Hainan Medical University,Haikou 570100,China)

机构地区：[1]海南医学院第一附属医院脊柱外科,海南海口570100

出　　处：《海南医学院学报》2024年第17期1327-1334,共8页Journal of Hainan Medical University

基　　金：国家自然科学基金(82160435);海南医学院第一附属医学院青年培育基金(HYYFYPY202218)。

摘　　要：目的:通过多因素回归分析重度Lenke 1型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者矫形术后解剖参数的变化与患者术后肩部失衡的相关性,从而探讨重度AIS患者术中矫正程度对术后患者发生肩部失衡的影响。方法:本研究回顾性分析自2018年8月至2022年8月60例在我院行经后路青少年特发性脊柱侧凸矫形术治疗的重度Lenke 1型AIS患者,依据术后锁骨角绝对值是否>2°,将所有患者分为肩部平衡组及肩部失衡组,每组各30例患者。收集患者基本信息,测量所有患者的术前、术后及末次随访主胸弯(ain thoracic curve,MTC)、上胸弯(proximal thoracic curve,PTC)、锁骨角,计算术前柔韧性、术前锁骨角、术后及末次随访矫正率。结果:两组间60例患者术后平均随访时间为(16.98±1.76)月。肩部平衡组上胸弯柔韧性(30.21±2.17)%、上胸弯矫正率(64.50±6.10)%及术后PTC与术后MTC的矫正率比值(0.77±0.85)显著大于肩部失衡组的(27.50±3.61)%、(55.42±1.67)%及(0.67±0.25),两组间差异具有统计学意义(P=0.001,P<0.01,P<0.01)。而肩部失衡组术后上胸弯Cobb(10.60±1.89)°及术后PTC与术后MTC Cobb角比值(0.86±0.20)却大于肩部平衡组的(8.17±1.32)°、(0.72±0.21)(P<0.01,P=0.009)。多因素logistics回归分析显示上胸弯矫正率是影响肩部失衡的危险因素。结论:术中上胸弯矫正率是影响重度Lenke 1型AIS患者术后肩部失衡的危险因素。因此,术中术者对重度Lenke 1型AIS患者主胸弯矫正时需要对上胸弯的矫正加以重视,避免术后出现肩部失衡的发生。Objective:To analyze the correlation between the changes of postoperative anatomical parameters and postopera⁃tive shoulder imbalance in patients with severe Lenke type 1 adolescent idiopathic scoliosis(AIS),using multivariate regression analysis in order to explore the effect of intraoperative correction on postoperative shoulder imbalance in patients with severe AIS.Methods:This study retrospectively analyzed 60 patients with severe Lenke type 1 AIS who underwent posterior scoliosis correc⁃tion and internal fixation assisted by computer navigation in our hospital from August 2018 to August 2022.According to whether the absolute value of postoperative clavicle angle was>2°,all patients were divided into the shoulder balance group and the shoulder imbalance group,with 30 patients in each group.The basic information of the patients was collected.The main thoracic curve(MTC),proximal thoracic curve(PTC)and clavicle angle of all patients were measured before,after and at the last follow⁃up.The preoperative flexibility,preoperative clavicle angle,postoperative and last follow⁃up correction rate were calculated.Re⁃sults:The average follow⁃up time of 60 patients between the two groups was(16.98±1.76)months.The proximal thoracic curve flexibility(30.21±2.17)%,the proximal thoracic curve correction rate(64.50±6.10)%and the ratio of postoperative PTC to postoperative MTC correction rate(0.77±0.85)in the shoulder balance group were significantly higher than those in the shoulder imbalance group(27.50±3.61)%,(55.42±1.67)%and(0.67±0.25).The difference between the two groups was statistically significant(P=0.001,P<0.01,P<0.01).But the proximal thoracic curve Cobb(10.60±1.89)°and the ratio of postoperative PTC to postoperative MTC Cobb(0.86±0.20)in the shoulder imbalance group were greater than those in the shoulder balance group(8.17±1.32)°and(0.72±0.21)(P<0.01,P=0.009).However,multivariate logistic regression analysis showed that the correction rate of proximal thoracic curve was a risk factor for s

关 键 词：青少年特发性脊柱侧凸 肩部平衡 肩部失衡 手术 

分 类 号：R687.3[医药卫生—骨科学]