| 王云生,海涌,康南,等.Lenke 1A型青少年特发性脊柱侧凸后路选择性胸弯融合术后远端附加现象的长期随访研究.骨科,2023,14(1): 9-13. |
| Lenke 1A型青少年特发性脊柱侧凸后路选择性胸弯融合术后远端附加现象的长期随访研究 |
| Long Term Follow-up of Distal Adding-on after Posterior Selective Thoracic Fusion for Lenke 1A Adolescent Idiopathic Scoliosis. |
| 投稿时间：2022-12-30 |
| DOI：10.3969/j.issn.1674-8573.2023.01.004 |
| 中文关键词: 青少年特发性脊柱侧凸 远端附加现象 肩平衡 脊柱融合术 并发症 |
| 英文关键词: Adolescent idiopathic scoliosis Distal adding-on Shoulder balance Spinal fusion Complications |
| 基金项目:科技部国家重点研发计划项目（2019YFC0120604）；北京市自然科学基金-海淀原始创新联合基金资助项目（L202006） |
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| 中文摘要: |
| 目的 探讨Lenke 1A型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）行后路选择性胸弯融合术后出现远端附加现象的长期随访结果。方法 回顾性分析2010年1月至2017年6月于我院行后路选择性胸弯融合术治疗的114例Lenke 1A型AIS病人的病例资料，筛选出术后出现远端附加现象病人共21例（18.4%），其中男4例，女17例。测量发生远端附加现象病人在术后即刻、发生远端附加现象时、术后1年、术后2年与末次随访的站立位脊柱全长正位片，对比上述时间节点的冠状面平衡、远端Cobb角、远端固定椎（lowest instrumented vertebra，LIV）下位椎间隙冠状面成角、LIV下位椎体偏离骶骨中垂线（center sacral vertical line，CSVL）距离、双肩高度差（shoulder height difference，SHD）、T1倾斜角、锁骨角等影像学参数。评估远端附加现象发生后的长期随访变化。结果 21例出现远端附加现象的病人均获完整随访，随访时间为（64.7±3.2）个月（61~68个月）。19例病人（90.5%）于术后6个月内出现远端附加现象，余2例（9.5%）在术后1年随访时出现。2例病人均采用支具治疗后好转。本组病人中无再手术病例。病人在发生远端附加现象时的肩平衡参数（SHD、T1倾斜角及锁骨角）较术后即刻时显著降低，差异有统计学意义（P＜0.05）。对比发生远端附加现象时、术后1年、术后2年及末次随访时，病人的影像学参数无明显变化（P＞0.05）。结论 Lenke 1A型AIS选择性胸弯融合术后远端附加现象多在术后6个月内发生，发生远端附加现象时病人的肩平衡参数与术后有显著差异。长期随访表明远端附加现象多数进展缓慢，长期随访相对稳定，而对于出现进展的远端附加现象可采用支具保守治疗。 |
| 英文摘要: |
| Objective To evaluate long-term outcomes of distal adding-on in Lenke 1A adolescent idiopathic scoliosis (AIS) after selective thoracic fusion. Methods A total of 114 patients who were diagnosed as having Lenke 1A AIS and treated with selective thoracic fusion from January 2010 to June 2017 were analyzed in this study. There were 21 patients (18.4%) suffered from distal adding-on among the patients, including 4 males and 17 females. The coronal balance, Cobb angle of the distal curve, intervertebral angle of distal lowest instrumented vertebra (LIV) in coronal plane, distance from LIV+1 to center sacral vertical line (CSVL), shoulder height difference, T1 tilt and clavicle angle were measured as radiographic parameters after surgery, after distal adding-on, 1 year after surgery, 2 years after surgery and at last follow-up. All the parameters were compared to evaluate long-term outcomes after distal adding-on. Results The follow-up time was (64.7±3.2) months (ranging from 61 to 68) of 21 patients with distal adding-on. A total of 19 patients (90.5%) suffered from distal adding-on in 6 months after surgery. Two patients (9.5%) in the study showed progressive distal adding-on in one year after surgery and brace was used as conservative treatment for them. As a result, no revision surgery was undergone in the study. The shoulder balance parameters such as SHD, T1 tilt and clavicle angle, showed significant difference after distal adding-on from that after surgery (P＜0.05). However, no significant difference was detected in radiographic parameters after distal adding-on and follow-ups (P＞0.05). Conclusion Distal adding-on in Lenke 1A AIS after selective thoracic fusion usually occurs within 6 months after operation. The shoulder balance showed significant difference after distal adding-on. Long-term outcomes showed that it progresses slowly and is relatively stable. Progressive distal adding-on could be treated by conservative treatment such as brace. |
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