Lenke 1型特发性脊柱侧凸患者术后双肩平衡的影响因素分析

Analysis of factors associated with postoperative shoulder balance in Lenke Type 1 adolescentidiopathic scoliosis

目的探讨影响术前右肩高的Lenke1型青少年特发性脊柱侧凸（AIS）患者主胸弯融合术后双肩平衡的相关因素。方法回顾性分析2006年10月至2008年10月行后路主胸弯融合术随访超过2年的34例Lenkel型AIS患者资料，其中男性8例，女性26例；年龄12～19岁，平均15．1岁。23例患者上端固定至T4，11例固定至T，。Pearson相关分析研究本组病例末次随访时影像学肩关节高度（RSH）与术前的T1倾斜、锁骨角、喙突高度差、顶椎偏移距离、RSH、上胸弯和主胸弯的Cobb角、Bending位Cobb角、柔韧度以及末次随访时主胸弯矫正率的相关性。结果所有患者术前均表现为右肩高于左肩，平均RSH为（一15．94-5．8）him，术后随访时间2～5年，平均2．8年。末次随访时，上胸弯和主胸弯Cobb角平均矫正率分别为44％4-16％和70％±10％；本组患者平均RSH为（0．4±7．9）nnn，其中32例获得满意的双肩平衡，仅有2例发生轻度的双肩失平衡，均表现为左肩高于右肩。相关分析显示末次随访的RSH与上胸弯柔韧度呈显著负相关关系（r=-0．682，P〈0．01），而与上胸弯Binding位Cobb角（r=0．642，P〈0．01）和主胸弯矫正率（r=0．557，P〈0．01）呈显著正相关关系。术前RSH、T1倾斜、锁骨角、喙突高度差、顶椎偏移距离、上胸弯和主胸弯的Cobb角，主胸弯Bending位Cobb角与末次随访的RSH均无相关性（P〉0．05）。结论术前右肩高的Lenke1型患者行主胸弯融合术，上端融合至T4或L椎体可获得满意的双肩平衡，上胸弯柔韧度偏低和主胸弯过度矫正可能与此类患者术后双肩失平衡相关。

Objective To study the factors associated with postoperative shoulder balance in Lenke Type 1 adolescent idiopathic scoliosis （AIS） patients with preoperative right-elevated shoulder after posterior thoracic fusion. Methods A total of 34 Lenke Type 1 AIS patients were recruited between October 2006 to October 2008. There were 8 boys and 26 girls with an average age of 15.1 years （range, 12-19 years）. Posterior thoracic fusion was performed in all the patients. There were 23 cases proximally fused to T4 and 11 cases fused to T5. Pearson＇s correlation analysis was made between radiographic shoulder height （RSH） at the latest follow-up and preoperative T~ tilt, clavicle angle （ CA ）, coracoids process height （ CPH ）, apical vertebral translation （AVT）, RSH, coronal and bending proximal/main thoracic curve （PT and MT） Cobb angle, curve flexibility as well as correction ratio of the MT curve. Results All patients presented right-elevated shoulder preoperatively, with an mean RSH of （ - 15.9 ±5.8 ） mm. At the latest follow-up, PT curve correction was 44%± 16% , and MT curve correction was 70% ±10%. Of the 34 patients with an average postoperative RSH of （0. 4 ± 7.9）mm,32 patients had balanced shoulders, and only 2 patients had mild shoulder imbalance with left-elevated shoulder. The RSH at the latest follow-up was found to be negatively correlated with PT curve flexibility （ r = - 0. 682, P 〈 0. 01 ） , but positively correlated with bending PT Cobb angle （ r = 0. 642, P 〈 0. 01 ） and correction ratio of the MT curve （ r = 0. 557, P 〈0. 01 ）. No significant correlations were found between RSH at the latest follow-up and preoperative T~ tilt, CA, CPH, AVT, RSH, coronal PT and MT Cobb angle, bending Cobb angle as well as flexibility of MT curve （ P 〉 0. 05 ）. Conclusions For the Lenke Type 1 AIS patients with preoperative right-elevated shoulder, proximal fusion to T4 or T5 could improve shoulder balance significantly. However, the low PT curve flexibility and overcorrection of MT curve may be associated with postoperative shoulder imbalance in such patients.