CAJ | 학술논문

目的比较后路选择性融合胸弯或胸腰弯/腰弯矫正青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)后代偿弯的自发性矫形.方法回顾性分析随访2年以上的双弯型AIS患者共41例(男6例,女35例),手术时平均年龄为13.8(11～16)岁,随访时间平均29(24～36)个月.北京协和医学院(Peking Union Medical College Hospital,PUMC)分型Ⅱb1型13例,Ⅱc1型5例,Ⅱc3型7例,Ⅱd1型16例.分为选择性胸弯融合(STF)组21例和选择性胸腰弯/腰弯融合组(SLF)20例.术前、术后和随访2年时摄站立位全脊柱正侧位和术前仰卧位左右弯曲像.结果 STF组和SLF组融合节段分别为(9.1±0.9)个和(5.5±0.7)个;术前和术后随访2年以上躯干偏移(TS)在STF组分别为(14.8±7.8)mm和(11.4±5.9)mm(P=0.048);SLF组为(24.7±7.3)mm和(13.2±4.9)am(P＜0.001);STF组代偿性腰弯由37.7°±6.8°自发矫形为15.1°±8.4°(P=0.001);SLF组代偿性胸弯由27.4°±6.7°自发矫形为14.9°±5.0°(P＜0.001).术前和术后2年在STF组中胸后凸由18.0°±6.8°降至13.5°±7.6°(P＜0.01),腰前凸由37.9°±8.4°增至43.8°±6.8°(P＜0.05);SLF组中胸后凸由12.8°±7.8°增至28.4°±10.8°(P＜0.001),腰前凸由33.4°±8.8°增至39.6°±6.9°(P＜0.05).两组术前与术后即刻、术后2年腰弯Lenke分型差异有统计学意义(P＜0.001).结论后路全节段椎弓根螺钉系统选择性融合胸弯或胸腰弯/腰弯矫正AIS代偿弯在冠状面、矢状面上自发性矫形程度不同,腰弯Lenke分型在两组中变化明显.
목적 비교후로선택성융합흉만혹흉요만/요만교정청소년특발성척주측철(adolescent idiopathic scoliosis,AIS)후대상만적자발성교형.방법 회고성분석수방2년이상적쌍만형AIS환자공41례(남6례,녀35례),수술시평균년령위13.8(11～16)세,수방시간평균29(24～36)개월.북경협화의학원(Peking Union Medical College Hospital,PUMC)분형Ⅱb1형13례,Ⅱc1형5례,Ⅱc3형7례,Ⅱd1형16례.분위선택성흉만융합(STF)조21례화선택성흉요만/요만융합조(SLF)20례.술전、술후화수방2년시섭참립위전척주정측위화술전앙와위좌우만곡상.결과 STF조화SLF조융합절단분별위(9.1±0.9)개화(5.5±0.7)개;술전화술후수방2년이상구간편이(TS)재STF조분별위(14.8±7.8)mm화(11.4±5.9)mm(P=0.048);SLF조위(24.7±7.3)mm화(13.2±4.9)am(P＜0.001);STF조대상성요만유37.7°±6.8°자발교형위15.1°±8.4°(P=0.001);SLF조대상성흉만유27.4°±6.7°자발교형위14.9°±5.0°(P＜0.001).술전화술후2년재STF조중흉후철유18.0°±6.8°강지13.5°±7.6°(P＜0.01),요전철유37.9°±8.4°증지43.8°±6.8°(P＜0.05);SLF조중흉후철유12.8°±7.8°증지28.4°±10.8°(P＜0.001),요전철유33.4°±8.8°증지39.6°±6.9°(P＜0.05).량조술전여술후즉각、술후2년요만Lenke분형차이유통계학의의(P＜0.001).결론 후로전절단추궁근라정계통선택성융합흉만혹흉요만/요만교정AIS대상만재관상면、시상면상자발성교형정도불동,요만Lenke분형재량조중변화명현.
Objective To compare spontaneous curve correction on the coronal and sagittal plane in adolescent idiopathic scoliosis(AIS)underwent selective posterior thoracic or lumbar fusion.Methods Forty-one patients with AIS receiving selective posterior correction and fusion with pedicle screw-only constructs over 2 years follow-up were reviewed.There were 6 males and 35 females with an average age of 13.8 years.The curves included 13 cases of PUMC Ⅱb1,5 of Ⅱc1,7 of Ⅱc3 and 16 of Ⅱd1.All patients were divided in-to two groups: selective thoracic fusion group(STF,n=21)and selective lumbar fusion group(SLF,n=20).Results The average fused vertebrae was 9.1±0.9 segments in STF group and 5.5±0.7 in SLF group.The trunk shift(TF)decreased from(14.8±7.8)mm before surgery to(11.4±5.9)mm at final follow-up(P=0.048)in STF group and from(24.7±7.3)mm to(13.2±4.9)mm in SLF group.The spontaneous lumbar curve de-creased from 37.7°±6.8° to 15.1°±8.4°(P=0.001)in STF group.The spontaneous thoracic curve decreased from 27.4°±6.7° to 14.9°±5.0° in SLF group(correction rate: 47.34%,P＜0.001).The thoracic kyphosis was corrected from 18.0°±6.8° before surgery to 13.5°±7.6° at final follow-up(P＜0.01)and lumbar lordosis from37.9°±8.4° to 43.8°±6.8°(P＜0.05)in STF group.The thoracic kyphosis was corrected from 12.8°±7.8° before surgery to 28.4°±10.8° at final follow-up(P＜0.01)and lumbar lordosis from 33.4°±8.8° to 39.6°±6.9°(P＜0.05)in SLF group.Lenke classification was also significantly different before surgery and at final follow-up(P＜0.001).Conclusion The different spontaneous curve correction on the coronal and sagittal plane in both groups was noted,and the lumbar curve classification is also corrected.