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.
Abstract
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 preopera-tive LIV+1 offset CSVL distance,postoperative parietal offset distance,main thoracic kyphosis Cobb angle cor-rection rate in the immediate postoperative period and at the final follow-up,lumbar kyphosis Cobb angle cor-rection rate at the final follow-up,Risser's sign,and LIV-SV segmental gap(P all＜0.05).Variables with sta-tistically 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 vertebrae(SV-1)can prevent the occurrence of distal AO.
基金项目
宁夏回族自治区重点研发计划(2023BEG02017)
宁夏医科大学总医院医工专项(NYZYYG-005)
维普
万方数据