文章摘要
孙泽宇,李波,简月奎,等.Lenke 1型青少年特发性脊柱侧凸病人矫形术后肩平衡的相关因素分析.骨科,2021,12(6): 499-504.
Lenke 1型青少年特发性脊柱侧凸病人矫形术后肩平衡的相关因素分析
Related Factors of Postoperative Shoulder Balance in Adolescent Idiopathic Scoliosis after Surgery
投稿时间:2021-06-26  
DOI:10.3969/j.issn.1674-8573.2021.06.003
中文关键词: 青少年特发性脊柱侧凸  肩平衡  主胸弯矫正率  上胸弯柔韧度
英文关键词: Adolescent idiopathic scoliosis  Shoulder balance  Correction of main thoracic curve  Proximal thoracic curve flexibility
基金项目:黔科合支撑[2019]2798号
作者单位E-mail
孙泽宇 贵州省人民医院骨科贵阳 550002  
李波 贵州省人民医院骨科贵阳 550002 libo3@medmail.com.cn 
简月奎 贵州省人民医院骨科贵阳 550002  
罗旭 贵州医科大学贵阳 550001  
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中文摘要:
      目的 探讨术前右肩高Lenke 1型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)病人术后的肩关节高度变化,并分析术后肩平衡的影响因素。方法 回顾性分析2015年1月至2017年12月于我院手术治疗的术前右肩高Lenke 1型AIS病人41例,根据术后肩部平衡状态分为双肩平衡组和双肩失衡组。分别测量两组病人术前、术后3个月及术后2年的影像学肩关节高度差(radiographic shoulder height,RSH)、上胸弯Cobb角、主胸弯Cobb角、锁骨角、胸廓锁骨角度差(clavicle chest cage angle difference,CCAD)和T1倾斜角,并计算主胸弯矫正率、上胸弯矫正率、主胸弯柔韧度、上胸弯柔韧度等;分析双肩失衡组病人末次随访时RSH与术前影像学指标的相关性。结果 双肩失衡组术前的锁骨角和CCAD值均高于双肩平衡组,上胸弯柔韧度低于双肩平衡组(P<0.05)。Pearson相关分析显示术前锁骨角、CCAD与术后RSH呈正相关(P<0.05,r>0);上胸弯柔韧度与术后RSH呈负相关(P<0.05,r<0);锁骨角变化、主胸弯及上胸弯矫正率、主胸弯角度变化与RSH变化呈正相关(P<0.05,r>0)。Logistic回归分析未见双肩失平衡的独立危险因素。结论 术前锁骨角、CCAD及上胸弯柔韧度是Lenke 1型AIS病人术后RSH的预测因素,应避免主胸弯过度矫正导致术后肩失衡的发生。
英文摘要:
      Objective To investigate the changes of shoulder height in Lenke 1 adolescent idiopathic scoliosis (AIS) patients with preoperative right-elevated shoulder after surgery and to analyze the factors associated with postoperative shoulder balance. Methods A total of 41 Lenke 1 AIS patients with preoperative right-elevated shoulder treated in our hospital from January 2015 to December 2017 were retrospectively analyzed. They were divided into balance group and imbalance group according to the postoperative shoulder balance status. The X-rays were taken to measure radiographic parameters, including radiographic shoulder height (RSH), the proximal thoracic curve Cobb angle, the main thoracic curve Cobb angle, clavicle angle, clavicle chest cage angle difference (CCAD) and T1 tilt angle at 3rd month after operation and the last follow-up. The correction of main thoracic curve, the correction of proximal thoracic curve, the main thoracic curve flexibility and the proximal thoracic curve flexibility were calculated. The correlations between the RSH and preoperative radiographic parameters were evaluated. Results The preoperative clavicular angle and CCAD were greater, and the proximal thoracic curve flexibility was lower in the imbalance group than that in the balance group (P<0.05). Preoperative clavicular angle and CCAD were positively correlated with the last follow-up RSH (P<0.05, r>0), and the proximal thoracic curve flexibility was negatively corrected with the last follow-up RSH (P<0.05, r<0). The change of clavicular angle, the change and correction of main thoracic curve and the correction of proximal thoracic curve were significantly correlated with the change of RSH (P<0.05, r>0). No independent risk factors were found in the Logistic regression analysis (P>0.05). Conclusion Preoperative clavicular angle, CCAD and the proximal thoracic curve flexibility are predictors of postoperative RSH in patients with Lenke 1 AIS. The occurrence of postoperative shoulder imbalance caused by overcorrection of the main thoracic curve should be avoided.
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