| 田振,李劼,刘昌伟,等.不同Risser征的Lenke 1型青少年特发性脊柱侧凸前路矫形术后远期胸椎后凸重建.骨科,2023,14(1): 34-39. |
| 不同Risser征的Lenke 1型青少年特发性脊柱侧凸前路矫形术后远期胸椎后凸重建 |
| Reconstruction of Thoracic Kyphosis Following Anterior Corrective Surgery in Lenke 1 Adolescent Idiopathic Scoliosis Patients with Different Risser Signs at Long Term Follow-up |
| 投稿时间：2022-12-31 |
| DOI：10.3969/j.issn.1674-8573.2023.01.008 |
| 中文关键词: 青少年特发性脊柱侧凸 前路手术 脊柱融合术 |
| 英文关键词: Adolescence idiopathic scoliosis Anterior operation Spinal fusion |
| 基金项目:国家自然科学基金（82072518）；南京市医学科技发展项目（ZKX22017） |
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| 中文摘要: |
| 目的 探讨不同Risser征的Lenke 1型青少年特发性脊柱侧凸（adolescence idiopathic scoliosis，AIS）前路矫形术后远期胸椎后凸角（TK）变化的差异。方法 回顾性分析2002年6月至2007年7月在我院接受前路矫形术治疗的40例Lenke 1型AIS病人的临床资料，病人年龄为（14.1±1.7）岁，其中男3例，女37例。根据病人Risser征评分将其分为三组：A组（Risser 0）、B组（Risser 1~3）和C组（Risser 4~5）。分别测量每例病人术前、术后即刻、术后第2年随访及末次随访时的正侧位X线片上的以下参数：胸主弯和代偿腰弯的冠状面Cobb角、TK（T5~T12）、前椎体高度（VBHa）、后椎体高度（VBHp）、椎弓根高度（PH）以及椎弓根间高度（IPH），并计算T5~T12的前椎体高度总和（SVBHa）、后椎体高度总和（SVBHp）、椎弓根高度总和（SPH）、椎弓根间高度总和（SIPH）、SVBHp/SVBHa和（SIPH+SPH）/SVBHa。结果 术后对三组病人进行了长达5~13年（平均6.5年）的随访。相较于术后即刻测量的TK，末次随访时A组的TK平均值显著增加（增加13.7°），但B组和C组两次随访时的平均TK值未见明显增大。40例病人中有11例（27.5%）末次随访时的TK值较术后即刻显著增大，其中6例（85.7%）来自A组，这一比例显著高于B组（21.4%）和C组（10.5%）。末次随访时，40例病人的平均SVBHp、SPH+SIPH、SVBHp/SVBHa以及（SIPH+SPH）/SVBHa均显著高于术后即刻，差异有统计学意义（P＜0.05）；其中A组的平均SVBHp/SVBHa、（SIPH+SPH）/SVBHa在末次随访时较术后即刻显著增加，差异有统计学意义（P＜0.05）；而B、C两组均未见显著差异。结论 Lenke 1型AIS前路选择性融合术后远期有27.5%的病人发生了显著的胸椎后凸重建，这可能与低Risser征病人脊柱后份持续生长相关。 |
| 英文摘要: |
| Objective To investigate the long-term changes of thoracic kyphosis (TK) following anterior corrective surgery in Lenke 1 adolescent idiopathic scoliosis (AIS) patients with different Riser signs. Methods We retrospectively reviewed 40 AIS patients (Lenke 1) who received anterior selective fusion in our institution from June 2002 to July 2007. The patients were (14.1±1.7) years old, including 3 males, 37 females. The patients were divided into three groups according to the preoperative Risser signs: group A (Risser 0), group B (Risser 1-3) and group C (Risser 4-5). The following parameters were measured on the posterior-anterior and lateral X-ray films before the operation, immediate post-operation, 2-year follow-up and the final follow-up: coronal Cobb angles of main thoracic curve and compensatory lumbar curve, TK (T5-T12), anterior vertebral body height (VBHa), posterior vertebral body height (VBHp), pedicle height (PH), inter pedicle height (IPH). The sum of anterior vertebral body height (SVBHa), posterior vertebral body height (SVBHp), pedicle height (SPH), inter pedicle height (SIPH), SVBHp/SVBHa, (SIPH+SPH)/SVBHa of T5-T12) were calculated. Results Patients in all three groups were followed up for 5 to 13 years (mean 6.5 years). Compared with the TK measured immediately after operation, TK was significantly increased (13.7°) at the final follow-up in group A. But no significant increase was observed at 2-year follow-up and the final follow-up in group B and group C. At the last follow-up, the TK of 11 cases (27.5%) was significantly improved compared with that immediately after operation, including 6 cases (85.7%) in group A. The incidence of significant TK increase was obviously higher in group A than group B (21.4%) and group C (10.5%). The SVBHp, SPH+SIPH, SVBHp/SVBHa and (SIPH+SPH)/SVBHa of 40 patients were significantly higher than those immediately after operation at the final follow-up, with statistically significant (P＜0.05). The SVBHp/SVBHa and (SIPH+SPH)/SVBHa in group A were significantly increased at the final follow-up compared with those immediately after operation (P＜0.05). But these differences were not observed in group B and group C. Conclusion At the long-term follow-up, 27.5% of patients with Lenke 1 AIS had significant TK reconstruction after anterior fusion, which may be associated with persistent growth of the posterior vertebra in patients with low Risser signs. |
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