| 方寅羽,李劼,刘昌伟,等.Lenke 5C型青少年特发性脊柱侧凸病人弯型特征及矫形疗效的性别差异.骨科,2023,14(2): 117-123. |
| Lenke 5C型青少年特发性脊柱侧凸病人弯型特征及矫形疗效的性别差异 |
| Gender Differences in Curve Pattern and Correction Rate in Patients with Lenke 5C Adolescent Idiopathic Scoliosis |
| 投稿时间：2023-01-20 |
| DOI：DOI：10.3969/j.issn.1674-8573.2023.02.006 |
| 中文关键词: 青少年 脊柱侧凸 矫形疗效 弯型特征 |
| 英文关键词: Adolescent Scoliosis Surgical outcome Curve pattern |
| 基金项目:国家自然科学基金（82072518）；十三五南京市卫生青年人才培养工程（QRX17126） |
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| 中文摘要: |
| 目的 探讨不同性别间Lenke 5C型青少年特发性脊柱侧凸（AIS）病人弯型特征及矫形疗效的差异。方法 回顾性分析2014年1月至2019年12月接受后路选择性胸腰椎融合术且有2年以上完整随访资料的Lenke 5C型AIS病人70例，男性组20例，女性组50例。对两组病人术前、术后即刻及末次随访时的胸腰弯/腰弯Cobb角、胸弯Cobb角等冠状面参数，胸椎后凸角（TK）、腰椎前凸角（LL）、近端交界性后凸角（PJA）等矢状面参数及脊柱侧凸研究学会-22简明量表调查问卷（SRS-22）评分进行比较分析。结果 男性组不典型弯型的比例高于女性组（20% vs. 12%），但组间差异无统计学意义（P＞0.05）。女性组和男性组的胸腰弯/腰弯Cobb角、胸弯Cobb角均较术前显著改善，且两组病人术后即刻和末次随访时的胸弯Cobb角比较，差异有统计学意义（P＜0.05）。两组术后胸腰弯/腰弯矫正率分别为70.6%±12.9%和72.6%±17.9%，末次随访时两组的矫正丢失率分别为5.3%±15.8%和7.6%±15.7%。女性组术前的TK明显低于男性组（19.2°±7.0° vs. 24.5°±14.5°），术前和术后即刻的矢状面平衡（SVA）均大于男性组，差异有统计学意义（P＜0.05）。末次随访时，男性组的近端交界性后凸（PJK）发生率高于女性组（30% vs. 16%），但差异无统计学意义（P＞0.05）。男性组在SRS-22量表疼痛维度上的得分显著高于女性组［（4.8±0.2）分 vs. （3.9±0.5）分］，差异有统计学意义（P＜0.05）。结论 男性Lenke 5C型AIS病人中表现为左胸弯右腰弯的不典型弯型的比例稍高于女性，女性病人的术前和术后即刻的SVA大于男性，但均可获得良好的长期矫形疗效。 |
| 英文摘要: |
| Objective To explore the gender differences in the curve pattern and surgical outcome of Lenke 5C adolescent idiopathic scoliosis (AIS). Methods From January 2014 to December 2019, 70 patients with Lenke 5C AIS who received posterior selective fusion and had more than 2 years of complete follow-up data were included, among which 20 were in the male group and 50 in the female group. The following parameters pre-operation, post-operation, and at the last follow-up including thoracolumbar/lumbar Cobb angle, thoracic Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), proximal junction angle (PJA) and other radiographic parameters were measured. These radiographic parameters and Scoliosis Research Society questionnaires-22 (SRS-22) scores were compared and analyzed. Results The proportion of atypical curvature in male group was higher than that in female group (20% vs. 12%), but the differences were not significant (P＞0.05). The thoracolumbar/lumbar Cobb angle and thoracic Cobb angle in the female group and male group were significantly improved as compared with those before the operation, and the differences between the two groups immediately after surgery and at last follow-up were statistically significant (P＜0.05). The correction rates of thoracolumbar/lumbar after surgery were 70.6%±12.9% in female group and 72.6%±17.9% in male group, and the correction loss rate at last follow-up were 5.3%±15.8% in female group and 7.6%±15.7% in male group, respectively. The pre-operative TK of the female group was significantly lower than that of the male group (19.2°±7.0° vs. 24.5°±14.5°), and the sagital verticle axis (SVA) before and immediately after surgery in the female group was greater than that in the male group, and the differences were statistically significant (P＜0.05). At the last follow-up, the incidence of proximal junctional kyphosis (PJK) was higher in male group than in female group (30% vs. 16%), but the difference was not statistically significant (P＞0.05). Moreover, the male group scored significantly higher on the pain dimension of the SRS-22 scale at the last follow-up than in the female group (4.8±0.2 vs. 3.9±0.5). Conclusion The proportion of male Lenke 5C AIS patients with atypical thoracic curve and right lumbar curve is slightly higher than that of female patients. The SVA of female patients before and immediately after surgery was higher than that of male patients, but both of them achieved satisfactory long-term surgical outcomes. |
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