Related factors affecting shoulder imbalance in patients with severe Lenke type 1 adolescent idiopathic scoliosis after orthopedic surgery
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 shoulder imbalance.Conclusion:The correction rate of proximal tho-racic curve during operation is a risk factor affecting postoperative shoulder imbalance in patients with severe Lenke type 1 AIS.Therefore,the surgeon should pay attention to the correction of the proximal thoracic curve when correcting the main thoracic curve in patients with severe Lenke type 1 AIS,in order to avoid the occurrence of shoulder imbalance after operation.
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