目的 评估Lenke 5C型青少年特发性脊柱侧凸(Adolescent idiopathic Scoliosis,AIS)上端融合椎(The upper instrumented vertebra,UIV)为上端椎(The upper end vertebra,UEV)和UEV+1对患者术后肩平衡的影响.方法 回顾性分析2012年1月至2019年12月48例Lenke 5C型AIS患者的资料,所有患者均行后路矫形选择性胸腰椎融合术,根据UIV和UEV之间的关系,将UIV作为UEV的设定为UEV组,将UIV作为UEV+1的设定为UEV+1组,比较两组影像学参数和临床结果的异同.结果 48例患者均随访2年以上,UEV组26例,UEV+1组22例.UEV+1组术后末次随访时TL/L矫正率明显高于UEV组(73.14％vs 63.71％,P＜0.05),UIV倾斜度明显降低,影像学的肩高度差(RSH)绝对值显著增加(7.63 mm vs 0.72 mm,P＜0.05),冠状面失衡绝对值显著增加(12.02 mmvs 4.81 mm,P＜0.05).UEV+1组术后肩失衡(RSH≥20 mm)发生率明显高于UEV组.两组在矢状位排列和患者预后方面差异无统计学意义(P＞0.05).结论 当UIV选择为UEV+1时,TL/L矫正率提高,但增加了肩和冠状面失衡的风险,临床应尽可能选择UEV作为UIV,以维持AIS患者肩平衡.
Effect of upper fusion vertebrae selection on postoperative shoulder balance in patients with Lenke 5C idiopathic scoliosis
Objective To evaluate the effect of Lenke 5C type adolescent idiopathic scoliosis(AIS)with up-per fusion vertebra(UIV)to upper vertebra(UEV)and UEV+1 on shoulder balance after the operation.Methods From January 2012 to December 2019,the data of 48 patients with Lenke 5C AIS were analyzed retrospectively.All patients underwent posterior orthopedic selective thoracolumbar fusion.According to the relationship between UIV and UEV,the patients with UIV as UEV were divided into UEV group and UIV with UEV+1 as UEV+1 group.The imaging parameters and clinical results between the two groups were compared.Results 48 patients were followed up for more than 2 years,including 26 patients in UEV group and 22 patients in UEV1 group.At the last follow-up,the TL/L correction rate in the UEV+1 group was significantly higher than that in the UEV group(73.14％vs 63.71％,P＜0.05).The inclina-tion of UIV was decreased significantly,the absolute value of RSH was increased significantly(7.63 mm vs 0.72 mm,P＜0.05),and the absolute value of coronal imbalance was increased significantly(12.02 mm vs 4.81 mm,P＜0.05).The incidence of postoperative shoulder imbalance(RSH ≥20 mm)in UEV+1 group was significantly higher than that in UEV group.There was no significant difference in sagittal ar-rangement and prognosis between the 2 groups(P＞0.05).Conclusion When UIV is selected as UEV+1,the TL/L correction rate is improved,but the risk of shoulder and coronal imbalance is increased.Clinical-ly,UEV should be selected as UIV as much as possible to maintain the overall balance of AIS patients.
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