先天性脊柱侧凸术前冠状面腰骶段椎间角与术后躯干偏移的观察

Relationship of preoperative coronal intervertebral angle changes in the lumbosacral region with postoperative trunk shift after congenital scoliosis surgery

目的分析单纯行后路矫形内固定的先天性脊柱侧凸患者术前冠状面腰骶段椎间角的变化与术后发生躯干偏移的关系。方法回顾性分析2010年1月至2014年6月北京协和医院骨科行后路矫形内固定手术治疗的921例先天性脊柱侧凸患者，记录并分析其冠状面躯干偏移、腰骶段术前和术后及随访时椎间角变化，以及脊柱侧凸Cobb角变化等数值。结果共38例患者完成超过6个月（平均12．4个月）的临床随访。患者术前腰骶段椎间角变化与随访中冠状面躯干偏移存在负相关（r=-0．51，P=0．001）。分别按照术前腰骶段椎间角变化和末次随访躯干偏移程度进行分组，其中术前腰骶段椎间角变化〈10。的患者在末次随访的躯干偏移要明显大于术前腰骶段椎间角变化≥10。的患者（32．5mm比12．4mm，P=0．001），而末次随访躯干偏移〈20mm的患者术前腰骶段椎间角变化也要明显大于末次随访躯干偏移≥20mm的患者（14．2°比6．0°，P=0．001）。结论通过术前冠状面腰骶段椎间角的变化可以预测先天性脊柱侧凸患者术后是否会发生不能自我矫正的躯干偏移，并指导手术方案的选择。

Objectives To investigate the relationship between the preoperative coronal intervertebral angle changes and postoperative trunk shift （TS） in patients who received congenital scoliosis correction. Methods The data of 921 patients with congenital scoliosis, who received posterior congenital scoliosis correction and internal fixation, was retrospectively analyzed. Anteroposterior （AP） whole spine standing radiographs and right and left lateral bending radiographs were taken preoperatively, and AP whole spine standing radiographs were obtained postoperatively and at the final follow-up. TS was measured in the coronal plane, and intervertebral angle change was the stun of the absolute values of IA-S1 intelwertebral angle changes in the coronal plane, and was determined before surgery, postoperatively, and at final follow- up. Results A total of 38 patients with a mean age of 16. 42 ± 8.36 years old and a mean follow-up of 12. 4 months （range, 6 to 36 months） were included. A median negative correlation were found between TS at the final follow-up and total variance of bending （ r = - 0. 51, P = 0. 001 ）. Groups were defined by two methods ： coronal intervertebral angle changes ≥ 10° or 〈 10°, and final follow-up TS 〈 20 mm or ≥ 20 mm. TS at the final follow-up was significantly greater in the 〈 10° group than the ≥ 10° group （32. 45 vs 12. 44 mm, P =0. 001 ）, and coronal intervertebral angle changes was significantly greater in the TS 〈 20 mm group than the ≥ 20 mm group （ 14. 2° vs 6°, P = 0. 001 ）. Conclusion Postoperative TS which will not compensate spontaneously can be predicted by measurement of the preoperative intervertebral interspace angle in the congenital scoliosis lumbosacral region.