CAJ | 학술논문

目的探讨青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)远端融合椎(low-est instrumented vertebra,LIV)的选择标准.方法前瞻性分析按LIV标准进行融合的随访2年以上(24～36个月,平均29个月)的AIS患者共33例,男4例,女29例.按照北京协和医学院(Peking Union Medical College Hospital)分型Ⅰ b 2例,Ⅰ c 2例,Ⅱa 3例,Ⅱb2 3例,Ⅱc1 3例,Ⅱd1 17例和Ⅲb 3例.患者手术时年龄11～16岁,平均14.2岁.LIV的选择标准:术前站立前后位像上被骶正中线触及的最近端椎体,即触及椎体,其旋转范围在Ⅰ度以内,并在凹侧Bending像上2/3以上椎体落在Harrington稳定区内,不伴腰段或胸腰段后凸畸形.所有患者均采用椎弓根螺钉固定.观测指标包括躯干偏移、LIV倾斜度和LIV尾侧椎间盘开角,并分析LIV与稳定椎之间的关系.结果术前和末次随访时躯干偏移由(1.87±1.18)cm矫正至(0.97±0.69)cm(t=3.24,P=0.004);术前和末次随访时LIV倾斜度由20.95°±7.51°矫正至4.57°±2.80°(矫正率为76.2%,t=10.10,P<0.001);术前和末次随访时的LIV尾侧椎间盘开角分别为4.90°±3.83°和5.43°±2.23°(t=0.14,P=0.626).选择触及椎体作为LIV比选择稳定椎平均节省(1.14±0.73)个椎体.结论按此触及椎体标准选择LIV可获得良好的矫形效果并可保留更多的运动节段.
목적 탐토청소년특발성척주측철(adolescent idiopathic scoliosis,AIS)원단융합추(low-est instrumented vertebra,LIV)적선택표준.방법 전첨성분석안LIV표준진행융합적수방2년이상(24～36개월,평균29개월)적AIS환자공33례,남4례,녀29례.안조북경협화의학원(Peking Union Medical College Hospital)분형Ⅰ b 2례,Ⅰ c 2례,Ⅱa 3례,Ⅱb2 3례,Ⅱc1 3례,Ⅱd1 17례화Ⅲb 3례.환자수술시년령11～16세,평균14.2세.LIV적선택표준:술전참립전후위상상피저정중선촉급적최근단추체,즉촉급추체,기선전범위재Ⅰ도이내,병재요측Bending상상2/3이상추체락재Harrington은정구내,불반요단혹흉요단후철기형.소유환자균채용추궁근라정고정.관측지표포괄구간편이、LIV경사도화LIV미측추간반개각,병분석LIV여은정추지간적관계.결과 술전화말차수방시구간편이유(1.87±1.18)cm교정지(0.97±0.69)cm(t=3.24,P=0.004);술전화말차수방시LIV경사도유20.95°±7.51°교정지4.57°±2.80°(교정솔위76.2%,t=10.10,P<0.001);술전화말차수방시적LIV미측추간반개각분별위4.90°±3.83°화5.43°±2.23°(t=0.14,P=0.626).선택촉급추체작위LIV비선택은정추평균절성(1.14±0.73)개추체.결론 안차촉급추체표준선택LIV가획득량호적교형효과병가보류경다적운동절단.
Objective To establish the criteria of the lowest instrumented vertebrae(LIV) for adoles-cent idiopathic scoliosis (AIS). Methods A consecutive of 33 cases with AIS receiving posterior correction and fusion following the LIV criteria with over 2 year follow-up (range, 24-36 months)were reviewed.There were 4 males and 29 females. The average age at surgery was 14.2 years. All cases were fused to the touched vertebra, which was defined as the most cephalad vertebrae touched by central sacrum vertical line with Grade Ⅰ or less rotation on the standing anterio-posterior radiograph, and two-thirds of its vertebral body can fall within the Harrington stable zone, and there was no kyphosis. The curve types included PUMC Ⅰ b in 2 cases, Ⅰ c in 2 cases, Ⅱ a in 3 cases, Ⅱ b2 in 3 cases, Ⅱ c1 in 3 cases, Ⅱ d1 in 17 cases and Ⅲb in 3 eases. All cases used pedicle screw fixation. Radiographic measurements included trunk shift (TS), lowest instrumented vertebrae tilting (LIVT), LIV distal disc angulation (LIVA) on the standing anterio-posterior ra-diographs before and after surgery and at the final follow-up. The difference of fusion levels were also recorded. The data were checked for normality and equal variances, and the level of significance was set at P<0.05. Results The TS was (1.87±1.18) cm before surgery and (0.97±0.69) cm at the final follow-up (t= 3.24, P=0.004). The LIVT was corrected from 20.95°±7.51° before surgery to 4.57°±2.80° at the final follow-up with a correction rate of 76.2%(t=10.10,P<0.001). The LIVA was 4.90°±3.83° before surgery and 5.43°± 2.23° at the final follow-up (t=0.14, P=0.626). Compared to fusion to the stable vertebrae, fusion to the touched vertebrae saved 1.14±0.73 mobile segments. Conclusion Fusion acording to this LIV criteria can achieve a good radiologic results and can save more mobile segments.