PUMC Ⅱb1型青少年特发性脊柱侧凸选择性胸弯融合术后即刻肩平衡影响因素分析

Influencing factors of shoulder balance after selective thoracic fusion for PUMC Ⅱb1 adolescent idiopathic scoliosis

目的:探究PUMC Ⅱb1型青少年特发性脊柱侧凸(AIS)选择性胸弯融合术后即刻肩平衡的影响因素,并构建回归方程以预测术后即刻肩平衡情况。方法:回顾性分析2015年1月至2021年6月诊断为PUMC Ⅱb1型AIS并行选择性胸弯融合手术的66例患者。以术后即刻影像学肩高(RSH)的绝对值>1 cm为肩失衡标准,分为肩平衡组(n=39)及肩失衡组(n=27)。搜集两组患者一般临床资料,测量并计算相关影像学参数,并进行比较;对术后即刻RSH与胸弯矫正度及胸腰弯/腰弯矫正度进行回归分析,构建多元线性回归方程。结果:高Risser征(P=0.029)、术前胸弯Cobb角较大(P=0.033)及术前腰弯柔韧度较差(P=0.025)的AIS患者术后即刻可能更容易出现肩失衡。多元线性回归分析拟合方程为:术后即刻RSH(cm)=0.069×胸弯矫正度(°)-0.058×胸腰弯/腰弯矫正度(°)-0.179。结论:胸弯与胸腰弯/腰弯的矫正度协调性是影响术后即刻肩平衡的重要因素,骨成熟度高、腰弯柔韧性差的患者术后即刻更容易出现肩失衡。

Objective: To explore the influencing factors of shoulder balance after selective thoracic fusion for PUMC Ⅱ b1adolescent idiopathic scoliosis, and to construct a regression equation to predict the immediate shoulder balance after operation.Methods: A total of 66 patients with PUMC Ⅱb1 AIS who underwent selective thoracic curvature correction and fusion surgery from January 2015 to June 2021 were enrolled in this retrospective study. Radiographic shoulder height(RSH) > 1 cm immediately after surgery was taken as the standard of shoulder imbalance, and the patients were divided into shoulder balance group(n=39) and shoulder imbalance group(n=27). Clinical data of the patients was collected. Relevant imaging parameters were measured and calculated.Regression analysis was used to assess the relationship between RSH and thoracic curvature and thoracolumbar/lumbar curvature immediately after operation. And multiple linear regression equation was constructed. Results: AIS patients with high Risser sign(P=0.029), large preoperative thoracic Cobb angle(P=0.033) and poor preoperative lumbar flexibility(P=0.025) were more prone to postoperative shoulder imbalance. Multiple linear regression analysis fitting equation: immediate postoperative RSH(cm) =0.069 ×thoracic curve correction(°)-0.058 × thoracolumbar/lumbar curve correction(°)-0.179. Conclusions: The correction coordination of thoracic curve and thoracolumbar/lumbar curve is an important factor affecting the immediate postoperative shoulder balance. Patients with high bone maturity and poor lumbar flexibility are more likely to have postoperative shoulder imbalance.