青少年特发性脊柱侧凸的脊柱后路矫形及其影响因素

Effects and influencing factors of posterior orthopedic surgery on adolescent idiopathic scoliosis

背景:后路矫形是治疗青少年特发性脊柱侧凸较为有效的方法,但目前关于青少年特发性脊柱侧凸患者后路矫形后脊柱高度的矫正程度及其影响因素鲜见报道。目的:分析后路矫形对青少年特发性脊柱侧凸患者的脊柱矫形效果及其影响因素。方法:回顾性分析青少年特发性脊柱侧凸患者346例的病历资料,其中单弯组203例,双弯组143例。测量患者矫形前后脊柱侧弯Cobb角和脊柱高度,采用逐步筛选回归法分析探讨性别、年龄、体质量、治疗前脊柱高度、治疗后脊柱高度、治疗前Cobb角、Cobb角矫正值、Cobb角矫正率、融合节段数、脊柱单弯或双弯、Lenke分型与矫形后脊柱高度增加值的关系。结果与结论:单弯组和双弯组患者矫形后的Cobb角均显著小于矫形前(P<0.05),脊柱高度显著高于矫形前(P<0.05),随着矫形前Cobb角的增加Cobb角减少值(?Cobb)和脊柱高度增加值(?SH)均显著增加(P<0.05)。多元线性回归分析结果显示Cobb角矫正值、治疗前Cobb角、治疗后脊柱高度、Lenke分型、脊柱单弯或双弯、年龄对治疗后脊柱高度增加值(?SH)有显著性影响(P<0.01),其中Cobb角矫正值是最大的影响因素。提示后路矫形对青少年特发性脊柱侧凸有显著的脊柱矫形效果,影响治疗后脊柱高度增加值的影响因素包括Cobb角矫正值、治疗前Cobb角、治疗后脊柱高度、Lenke分型、脊柱单弯或双弯、年龄。

BACKGROUND：Posterior orthopedic surgery is the more effective treatment of adolescent idiopathic scoliosis. However, there is rare study on the correction extent of spinal height and influential factors after posterior orthopedic surgery in patients with adolescent idiopathic scoliosis. OBJECTIVE：To explore the effect and influencing factors of posterior orthopedic surgery on adolescent idiopathic scoliosis. METHODS：Data of 346 adolescent idiopathic scoliosis patients were retrospectively analyzed. There were 203 cases in the single bend group and 143 cases in the double bend group. Cobb angle and vertebral column height were measured before and after orthopedic surgery. Stepwise regression analysis was used to explore the relationship of gender, age, weight, preoperative and postoperative spinal height, preoperative Cobb angle, Cobb angle correction value, Cobb angle correction rate, the number of fused joint, spine curved single or double bend, Lenke classification with the increased value of spinal height after surgery. RESULTS AND CONCLUSION：Cobb angles of single and double bend groups were significantly smal er after surgery than the preoperative angles （P〈0.05）, but spinal height was significantly higher after surgery than that before surgery in both groups （P〈0.05）. With the increase in the preoperative Cobb angle, the reduced value of Cobb angle （Δcobb） and the increase in spinal height （ΔSH） were significantly increased （P〈0.05）. Multiple linear regression analysis results showed Cobb angle correction value, preoperative Cobb angle, postoperative spine height, Lenke type, single curved or double curved spine, and age had significant effects on increased value of spine height （ΔSH） after treatment （P〈0.01）. The corrected value of Cobb angle was the greatest influential factor. These findings indicate that posterior correction has significant effects on adolescent idiopathic scoliosis. Factors affecting the increased value of spine height include Cobb angle, preoperative Cobb angle, postoperative spine height, Lenke type, single curved or double curved spine and age.