摘要
目的探寻导致行非选择性胸弯矫正治疗的Lenke 2型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者术后即刻发生肩关节失平衡的影像学因素。方法研究对象包括32例Lenke 2型AIS患者,女25例,男7例。所有患者上端固定至T1或T2水平。术前全脊柱片影像学测量指标包括:(1)锁骨角;(2)T1倾斜角;(3)上胸弯Cobb’s角;(4)主胸弯Cobb’s角;(5)上胸弯Bending位片Cobb’s角;(6)主胸弯Bending位片Cobb’s角;(7)上胸弯柔韧度;(8)主胸弯柔韧度;(9)上胸弯顶椎偏移距离(apical vertebrae translation,AVT);(10)主胸弯AVT;(11)术前肩关节影像学高度(radiographic shoulder height,RSH)。分析以上术前影像学指标,上胸弯矫正率以及主胸弯矫正率与术后RSH的相关关系。术后RSH>10 mm定义为肩关节失平衡。结果 6例(18.8%)术后发生肩关节失平衡。术前影像学指标与术后RSH相关性无统计学意义(P>0.05),仅有主胸弯术后矫正率与术后RSH相关性有统计学意义(P<0.05)。结论术前的影像学指标均无法预测行非选择性胸弯矫正的Lenke 2型AIS患者术后肩关节平衡情况。主胸弯过度矫正是导致术后肩关节失平衡的主要原因。
Objective To explore the radiographic factors associated with shoulder imbalance immediately after operation in Lenke type 2 adolescent idiopathic scoliosis( AIS) patients undergoing non-selective thoracic correction. Methods A total of 32 Lenke type 2 AIS patients( 25 females / 7 males) with proximal thoracic fusion to T1 or T2 level were included. The preoperative anteroposterior X-ray films of the whole spine were obtained in all these subjects with respect to the following parameters:( 1) Clavicle angle;( 2) T1 tilt;( 3) Proximal thoracic( PT) Cobb's angle;( 4) Main thoracic( MT) Cobb's angle;( 5) PT bending Cobb's angle;( 6) MT bending Cobb's angle;( 7) PT curve flexibility;( 8) MT curve flexibility;( 9) Apical vertebrae translation( AVT) of PT curve;( 10) AVT of MT curve and( 11) Radiographic shoulder height( RSH). The correlation analysis was used to evaluate the associations between postoperative RSH and other preoperative parameters, PT curve correction rate, as well as MT curve correction rate. The postoperative shoulder imbalance was defined as RSH more than 10 mm. Results Six( 18.8%) cases had shoulder imbalance immediately after operation. No preoperative parameter measured had significant association with postoperative RSH( P〉0.05). A positive association was found between postoperative RSH and MT curve correction rate( P〈0.05). Conclusions No preoperative parameter can predict postoperative shoulder balance in Lenke type 2 AIS patients undergoing non-selective thoracic fusion. The overcorrection of MT curve is the major risk factor associated with postoperative shoulder imbalance in these patients.
出处
《中国骨与关节杂志》
CAS
2017年第1期5-9,共5页
Chinese Journal of Bone and Joint
关键词
脊柱侧凸
脊柱弯曲
矫形外科手术
肩关节
Scoliosis
Spinal curvatures
Orthopedic procedures
Shoulder joint