Lenke1型青少年特发性脊柱侧凸后路矫形术后身高增加的影响因素分析

Factors correlated with height gain after posterior spinal correction surgery in lenke 1 adolescent idiopathic scoliosis

目的探讨Lenke1型青少年特发性脊柱侧凸（AIS）患者脊柱后路矫形术后身高增加（ASH）的影响因素并提出ASH的预测模型。方法选取2013至2015年南京大学医学院附属鼓楼医院脊柱外科行脊柱后路矫形手术的150例Lenke1型AIS患者，年龄（14．3±2．9）岁。于术前及术后即刻的站立位全脊柱正侧位片上测量主弯侧凸Cobb角、胸椎后凸角（TK）及腰椎前凸角（LL），并计算术后侧凸Cobb角、TK及LL的变化值。比较术前术后参数之间的差异并应用线性回归分析ASH的预测模型。结果脊柱高度（SH）术前为（41．6±3．0）cm，术后即刻为（43．9±2．7）cm[ASH=（2．4±0．8）am，P=0．000]；侧凸Cobb角术前为（50．5±10．4）°，术后即刻为（14．6±6．4）°（P=0．000）。Pearson相关性分析示ASH与术前SH（P=0．000）、术前侧凸Cobb角（P=0．000）、术前TK（P=0．000）、术后即刻SH（P=0．020）、术后即刻侧凸Cobb角（P=0．000）、Cobb角变化（P=0．000）及TK变化（P=0．000）均呈显著相关性。线性回归模型1示侧凸Cobb角变化（P=0．000）及TL变化（P=0．000）与ASH呈显著线性相关性（r2=0．305）；线性回归模型2示术前侧凸Cobb角（P=0．000）和术前TK（P=0．020）可用于预测术后ASH（r2=0．439）。结论Lenke1型AIS患者后路矫形术后身高的增加与术前术后侧凸Cobb角、术前TK、侧凸Cobb角变化值及TK变化值呈明显正相关。患者术前侧凸Cobb角及TK越大，则其术后身高的增加越明显。

Objective To investigate the correlated factors of height gain （ASH） after posterior spinal correction surgery in Lenke 1 adolescent idiopathic scoliosis （AIS）, and to propose the predictive model of ASH. Methods From 2013 to 2015, a total of 150 Lenke 1 AIS patients undergoing posterior spinal correction surgery were included in the study, with the age of （14. 3 ±2. 9） years. The Cobb angle of major curve, thoracic kyphosis （TK） and lumbar lordosis （LL） were measured on both pre-op and post-op standing whole spine x-rays. The change in Cobb angle, TK and LL were calculated. The difference between pre-operation and post-operation was compared and the linear regression analysis was used for the predictive model of ASH. Results The pre-op and post-op values were （41.6 ± 3.0） cm and （43.9 ± 2. 7 ） cm for spinal height （SH） [ ASH = （ 2.4 ± 0. 8 ） cm, P = 0. 000 ] ; （ 50. 5 ± 10. 4 ）° and （ 14.6 ± 6.4 ） o for Cobb angle （P = 0. 000）. The Pearson correlation analysis showed that ASH was significantly correlated with pre- op SH （ P = 0. 000）, pre-op Cobb angle （ P = 0. 0130 ）, pre-op TK （ P = 0. 0013 ）, post-op SH （ P = 0. 020 ）, post-op Cobb angle （P =0. 000）, change in Cobb angle （P =0. 000） and change in TK （P =0. 000）. The linear regression model 1 revealed that ASH was linearly correlated with change in Cobb angle （ P = 0.000 ） as well as change in TK （ P = 0. 000 ） ; the linear regression model 2 showed that the pre-op Cobb angle （P = 0. 000） and pre-op TK （P = 0. 020 ） could he used for the pre-op prediction of ASH. Conclusions The positively correlated factors of ASH include pre-op and post-op Cobb angle, TK, change in Cobb angle and change in TK. High pre-op Cobb angle and TK indicates high height gain in Lenke 1 AIS patients.