使用EOS影像系统评价Lenke 5型青少年特发性脊柱侧凸的手术矫形效果

Evaluation of posterior spinal fusion for adolescent idiopathic scoliosis Lenke type 5 using EOS radiography

目的使用EOS影像模拟三维重建方法评价后路悬臂梁联合直接椎体去旋转技术治疗Lenke 5型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)的畸形矫正效果。方法采用回顾性研究方法,选取2018年3月至2019年2月在我院治疗的16例AIS Lenke 5型患者,其中男1例,女15例,平均年龄(15.25±1.67)岁。在后路手术中,采用悬臂梁联合直接椎体去旋转的方法矫正畸形。对比术前及末次随访时临床及影像学指标。临床观察指标包括躯干倾斜角angle of trunk rotation,ATR)和脊柱侧凸学会-22r评分scoliosis research society-22r score,SRS-22r)。使用EOS评价影像学指标,包括冠状位[腰弯Cobb’s角、顶椎偏移距离apical vertebral translation,AVT)]、矢状位[胸椎后凸thoracic kyphosis,TK)、腰椎前凸lumbar lordosis,LL)]和轴位参数[顶椎旋转角apical vertebral rotation,AVR)]。结果本组平均随访15.67±3.01)个月。术前及末次随访ATR[(15.75±5.92)° vs.(5.13±1.46)°,P=0.002]、腰弯Cobb’s角[(41.25±7.00)° vs.(12.45±5.85)°,P < 0.001]、AVT[(4.49±1.30)cm vs.(1.15±0.65)cm,P < 0.001]、AVR[(20.44±4.42)° vs.(7.75±4.62)°,P < 0.001)]差异有统计学意义。以上参数矫正率进行 Pearson 相关分析,Cobb’s 角矫正率分别与 AVT 和 ATR 矫正率有统计学相关性r=0.729,P=0.040;r=0.706,P=0.050)。SRS-22r评分中,患者在自我形象方面评分有显著提高[(3.53±0.72)vs.(4.40±0.37),P=0.025]。结论 EOS影像系统可以准确地评估AIS患者椎体的旋转程度,进而有效地评价后路悬臂梁联合直接椎体去旋转技术治疗AIS Lenke 5型患者的影像学效果。此外,Lenke 5型 AIS 患者的冠状面侧凸矫正率与大体外观躯干倾斜改善率呈正相关。

Objective To evaluate the outcomes of cantilever and direct vertebral derotation via EOSthree-dimensional reconstruction in the treatment of adolescent idiopathic scoliosis (AIS) Lenke type 5.Methods A retrospective study was conducted focusing on 16 AIS Lenke type 5 patients from March,2018 to February,2019.There were 1 male and 15 females,with an average age of (15.25±1.67) years.Cantilever combined with direct vertebral derotation was used for deformity correction.Various clinical and radiographic parameters preoperatively and at the final follow-up were compared,including Angle of Trunk Rotation (ATR),Scoliosis Research Society-22r score (SRS-22r),Cobb’s angle of lumbar curve,Apical Vertebral Translation (AVT),Thoracic Kyphosis (TK),Lumbar Lordosis (LL) and Apical Vertebral Rotation (AVR).Results The average follow-up was (15.67±3.01) months.Statistical significance was found in ATR[(15.75±5.92) ° vs.(5.13±1.46) °,P=0.002],Cobb’s angle[(41.25±7.00) ° vs.(12.45±5.85) °,P < 0.001],AVT[(4.49±1.30) cm vs.(1.15±0.65) cm,P < 0.001]and AVR[(20.44±4.42) ° vs.(7.75±4.62) °,P < 0.001]preoperatively and at the final follow-up.Pearson analysis showed statistical correlations between Cobb’s angle correction rate and AVT correction rate (r=0.729,P=0.040),Cobb’s angle correction rate and AVR correction rate (r=0.706,P=0.050),respectively.Statistical improvement was found in self-image domain of SRS-22r score[(3.53±0.72) vs.(4.40±0.37),P=0.025].Conclusions The vertebral rotation of AIS could be evaluated effectively by EOS imaging which will further estimate the correction rate of AIS Lenke type 5 treated with cantilever and direct vertebral derotation.Besides,correction rate of coronal scoliosis in Lenke type 5 AIS patients is positively correlated with the improvement rate of ATR.