Lenke 2型青少年特发性脊柱侧弯患者术后双肩失平衡的风险因素分析

Risks of postoperative shoulder imbalance in Lenke type 2 adolescent idiopathic scoliosis

目的:探讨Lenke 2型青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)患者接受胸椎后路选择性矫形融合术术后双肩失平衡的风险因素。方法:系统性回顾分析168例接受胸椎后路选择性矫形融合术的Lenke 2型AIS患者术前、术后即刻与末次随访时站立位全脊柱X线片锁骨角(clavicle angle,CA)、影像学双肩高度差(radiographic shoulder height,RSH)、胸1椎体(T1)倾斜角、上胸弯(proximal thoracic,PT)Cobb角、主胸弯(main thoracic,MT)Cobb角、代偿性腰弯(compensatory lumbar curve,CL)Cobb角、主胸弯顶椎旋转度(the apical translation of the main thoracic curve,AVT)、术前各弯的柔韧性、术后各弯矫正率等影像学参数;利用独立样本t检验、卡方检验、logistic回归分析导致Lenke 2型AIS患者术后双肩失平衡的风险因素。结果:168例患者中,28例(16.7%)患者末次随访时出现术后双肩失平衡;独立样本t检验显示,术后双肩失平衡组其术前MT Cobb角明显大于术后双肩平衡组术前MT Cobb角;术后双肩失平衡组术后即刻RSH,末次随访时T1倾斜角、CA、RSH均明显大于术后双肩平衡组;此外,独立样本t检验还显示,2组患者间下端固定椎(lower instrumented vertebra,LIV)、远侧端椎(end vertebra,EV)、中位椎(neutral vertebra,NV)、颈7铅垂线所触及的最远端椎体(last vertebra that CSVL touches,LTV)水平存在统计学差异;logistic回归分析显示,术前站立位MT Cobb角度数(OR=1.112,95%CI=1.017~1.088,P=0.010)、LIV-LTV值(OR=2.635,95%CI=1.363~9.442,P=0.012)与术后双肩失平衡的发生具有显著相关性。结论:本研究提示Lenke 2型AIS患者前大MT Cobb角与大LIV-LTV差值对Lenke 2型AIS患者术后双肩失平衡的发生具有促进作用。

Objective：To systematicly investigate the risks of shoulder imbalance in Lenke type 2 adolescent idiopathic scoliosis（AIS） patients underwent selective posterior thoracic fusion surgery. Methods：Preoperative,postoperative and the last follow-up standing whole-spine radiographs of 168 consecutive patients with Lenke type 2 curves who underwent selective posterior thoracic fusion surgery were analyzed. Imaging parameters,including clavicle angle（CA）,radiographic shoulder height（RSH）,T1 title,proximal thoracic（PT）curve Cobb angle,Main thoracic curve（MT）Cobb angle etc were analyzed first by univariate analysis and Chi-squared analysis,and then stepwise logistic regression analysis. Results：Shoulder imbalance occurred in 28 patients（16.7%）at the last follow-up. Factors significantly associated with shoulder imbalance by univariate and Chi-squared analysis were magnitude of preoperative MT curve,the radiographic shoulder height（RSH）after surgery,T1 tilt,clavicle angle and RSH at follow-up,and the difference in levels between lower instrumented vertebra（LIV） and end vertebra（EV）,neutral vertebra（NV）,stable vertebra（SV） and the last toughing vertebra of CSVL（LTV）. Stepwise logistic regression analysis identified the magnitude of preoperative MT curve（OR=1.112,95%CI=1.017 to 1.088,P=0.010）and LIV-LTV（OR =2.635,95% CI =1.363 to 9.442,P =0.012） as factors significantly associated with shoulder imbalance.Conclusion：The magnitude of preoperative MT curve and selection of LIV may mainly influence the postoperative shoulder balance in Lenke type 2 curve.