早发型脊柱侧凸行生长棒矫正手术后颈椎矢状位参数变化及颈椎矢状位失平衡的风险因素分析

Changes of cervical sagittal parameters and risk factors for cervical sagittal imbalance after growth rod correction for early onset scoliosis

目的探讨早发型脊柱侧凸(early onset scoliosis,EOS)行生长棒矫正手术前后的颈椎矢状位参数变化,并分析颈椎矢状位失衡的风险因素,为临床及早制定干预措施提供参考。方法回顾性分析2013年7月-2018年7月在本院骨科接受生长棒矫正手术的41例EOS患儿资料,统计患者人口学资料、手术情况等临床资料;并分别于手术前、术后及末次随访时,在脊柱全长正侧位X片上测量其颈椎矢状位参数(T_(1)S、C_(2-7)Cobb角、C_(2-7)SVA等);此外,测量患儿手术前后的胸椎后凸角(thoracolumbar kyphosis,TK),腰椎前凸角(lumbar lordosis,LL),胸弯/胸腰弯Cobb角,以及最大后凸Cobb角,C_(7)-S_(1)的SVA参数值,计算其生长棒术后的胸弯矫形率、最大后凸Cobb角矫形率。对41例EOS患儿手术前、术后、末次随访时的颈椎矢状位参数变化情况进行分析,并依据C_(2-7)SVA值进行颈椎矢状位失衡与否的判定,进行潜在风险因素的组间单因素分析和多因素Logistic回归分析。结果与术前相比,41例EOS患者末次随访时的T_(1)S、C_(2-7)Cobb角、C_(2-7)SVA值均显著升高,差异有统计学意义(P<0.05);以C_(2-7)SVA值进行判定,41例中,13例随访期间出现颈椎矢状位失衡(失衡组),另28例颈椎矢状位平衡在正常范围(正常组)。经单因素分析,正常组患儿的年龄、T_(1)S变化值、PJK占比均明显小于失衡组;正常组的体质量指数、最大后凸角矫正率均明显大于失衡组。将上述因素纳入多因素Logistic回归分析,近端交界性后凸(proximal junctional kyphosis,PJK)(OR=11.293,P=0.000)是EOS患儿生长棒术后颈椎矢状位失衡的独立风险因素。结论生长棒矫正手术对EOS患儿的颈椎矢状位参数可产生一定影响,其中术后有PJK者应警惕出现颈椎矢状位失衡的风险。

Objective To investigate the changes of cervical sagittal parameters before and after the treatment of early onset scoliosis(EOS)with a growth stick,and to analyze the risk factors of cervical sagittal imbalance,so as to provide reference for early intervention.Methods The clinical data of 41 children with EOS who underwent growth rod correction surgery in our hospital from July 2013 to July 2018 were retrospectively analyzed,the demographic data,operation conditions and other clinical data of patients were analyzed.In addition,the thoracolumbar kyphosis angle(TK),lumbar lordosis angle(LL),thoracolumbar bending/thoracolumbar bending Cobb angle,as well as the maximum kyphosis Cobb angle,and the SVA parameters of C_(7)-S_(1) were measured before and after operation to calculate the postoperative thoracic curvature and maximum kyphosis Cobb angle.The changes of cervical sagittal parameters in 41 children with EOS before operation,after operation and at the last follow-up were analyzed,and the cervical sagittal imbalance was determined according to C_(2-7)SVA value,and the potential risk factors were analyzed by intergroup univariate analysis and multivariate logistic regression analysis.Results Compared with preoperative results,T_(1)S,C_(2-7)Cobb angle and C_(2-7)SVA values of 41 EOS patients were significantly increased at the last follow-up,and the differences were statistically significant(P<0.05).According to the C_(2-7)SVA value,13 cases of the 41 patients developed cervical sagittal balance(imbalance group)during follow-up,and the other 28 patients had normal sagittal balance(normal group).By univariate analysis,the age,T_(1)S change value and proximal junctional kyphosis(PJK)proportion of children in the normal group were significantly lower than those in the unbalanced group.The body mass index and maximum kyphosis correction rate of the normal group were significantly higher than those of the unbalance group.When the above factors were included in multivariate Logistic regression analysis,PJK(OR=11.293,P=0.000)was an independent risk factor for cervical sagittinal imbalance after growth rod operation in children with EOS.Conclusion Growth rod correction surgery has certain effect on the sagittal parameters of the cervical spine in children with EOS,among which those with PJK should be alert to the risk of cervical sagittal imbalance.