摘要
目的 分析影响Lenke 1型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)术后满意度的肩平衡影像学指标.方法 回顾性分析2017年8月至2020年7月于空军军医大学西京医院接受后路全椎弓根螺钉矫形融合术的AIS患者98例,男26例、女72例,年龄(15.2±5.3)岁(范围10～24岁).上端固定椎分布:T258例(59％)、T325例(26％)、T415例(15％);下端固定椎分布:T1263例(64％)、L128例(29％)、L24例(4％)、L33例(3％).比较手术前后锁骨角(claviclean-gle,CA)、影像学肩高(radiographic shoulder height,RSH)、喙突高度差(coracoid height difference,CHD)、锁骨肋骨交点高度差(clavicle-rib cage intersection difference,CRID)、Ti倾斜角、第 1 肋倾斜角、锁骨胸廓角度差(clavicle chest angle difference,CCAD)及脊柱侧凸研究学会22项量表(Scoliosis Research Society-22,SRS-22)结果.采用二分类logistic回归分析影响Len-ke 1型AIS术后满意度的肩平衡影像学指标.绘制受试者工作特征(receiver operating characteristic,ROC)曲线,确定该影像学指标的阈值.结果 所有患者均顺利完成手术,手术时间为(260±80)min(范围220～320 min),术中出血量为(360± 110)ml(范围300～700 ml),术中无一例出现神经、硬膜及血管损伤.末次随访时RSH、CHD、CRID、T1倾斜角、第1肋倾斜角、CCAD分别为4.0(0,13.9)mm、7.0(0,12.9)mm、4.0(0,10.0)mm、4.8°(3.3°,8.2°)、5.3°±3.9°、5.5°(3.0°,8.9°),小于术前的 10.6(2.0,20.3)mm、10.3(2.5,15.9)mm、8.0(1.0,15.2)mm、7.6°(3.5°,12.2°)、7.5°±6.9°、8.5°(3.6°,18.3°),差异有统计学意义(P＜0.05).末次随访时SRS-22功能、疼痛、外观、心理评分分别为4.6(4.0,4.9)分、(4.1±0.5)分、(4.1±0.7)分、4.2(3.9,4.8)分,均大于术前的4.2(3.8,4.6)分、(4.0±0.7)分、(3.5±0.7)分、4.0(3.5,4.4)分,差异有统计学意义(P＜0.05).二分类lo-gistic 回归结果显示,CCAD是影响AIS矫形术后满意度的独立肩平衡影像学指标(OR=0.826,P=0.040).ROC曲线示曲线下面积及95％CI为0.726(0.572,0.865),阈值为6.6°.结论 CCAD是影响AIS矫形术后满意度的独立肩平衡影像学指标,术后CCAD≤6.6°时患者更容易达到疗效满意,可作为评估脊柱矫形手术疗效的影像学指标应用于临床.
Abstract
Objective To analyze the radiographic parameters of shoulder balance that affect the postoperative satisfac-tion of Lenke type 1 adolescent idiopathic scoliosis(AIS).Methods A total of 98 patients with AIS who underwent posterior pedi-cle screw fusion in Xijing Hospital of Air Force Medical University from August 2017 to July 2020 were retrospectively analyzed.There were 26 males and 72 females,aged 15.2±5.3 years(range,10-24 years).Distribution of upper instrumented vertebrae:T258 cases(59％),T3 25 cases(26％),T415 cases(15％);Distribution of lower instrumented vertebrae:T12 63 cases(64％),L1 28 cas-es(29％),L2 4 cases(4％),L3 3 cases(3％).Clavicle angle(CA),radiographic shoulder height(RSH),and coracoid height differ-ence(CHD),clavicle-rib cage intersection difference(CRID),T1 tilt angle,first rib tilt angle,clavicle chest angle difference(CCAD)and Scoliosis Research Society-22(SRS-22)scale were compared before and after operation.Binary logistic regression was used to analyze the radiographic indicators of shoulder balance that affected the postoperative satisfaction of Lenke type 1 AIS.The receiver operating characteristic(ROC)curve was drawn to determine the threshold value of the imaging index.Results All operations were successfully completed.The operation time was 260±80 min(range,220-320 min),and the intraoperative blood loss was 360±110 ml(range,300-700 ml).There was no nerve,dural or vascular injury during operation.RSH,CHD,CRID,T1 tilt angle,first rib tilt angle,and CCAD at the final follow-up were 4.0(0,13.9)mm,7.0(0,12.9)mm,4.0(0,10.0)mm,4.8°(3.3°,8.2°),5.3°±3.9°,and 5.5°(3.0°,8.9°),respectively,which were less than the preoperative 10.6(2.0,20.3)mm,10.3(2.5,15.9)mm,8.0(1.0,15.2)mm,7.6°(3.5°,12.2°),7.5°±6.9°,8.5°(3.6°,18.3°),and the difference was statistically significant(P＜0.05).The SRS-22 function,pain,appearance,and psychological scores at the final follow-up were 4.6(4.0,4.9),4.1±0.5,4.1±0.7,and 4.2(3.9,4.8)points,respectively,which were greater than the preoperative scores of 4.2(3.8,4.6),4.0±0.7,3.5±0.7,and 4.0(3.5,4.4)points,the difference was statistically significant(P＜0.05).Binary logistic regression showed that CCAD was an inde-pendent radiographic indicator of shoulder balance that affected the satisfaction of AIS patients after orthopaedic surgery(OR=0.826,P=0.040).ROC curve showed that the area under the curve and 95％CI was 0.726(0.572,0.865),and the threshold was 6.6°.Conclusion CCAD is an independent radiographic parameter of shoulder balance that affects the postoperative satisfaction of AIS.Patients are more likely to achieve a satisfactory outcome when their postoperative CCAD is ≤6.6°,which can be used clin-ically as a radiographic parameter to assess the efficacy of orthopaedic spine surgery.
基金项目
中央高水平医院临床科研专项(2022-PUMCH-D-004)
西京医院颈腰痛专项研究项目(FXRYJYT05)
NETL
NSTL
万方数据