中国脊柱脊髓杂志
中國脊柱脊髓雜誌
중국척주척수잡지
CHINESE JOURNAL OF SPINE AND SPINAL CORD
2010年
1期
29-33
,共5页
邢泽军%仉建国%于斌%刘勇%刘景臣%汪学松%孙武%赵丽娟%邱贵兴
邢澤軍%仉建國%于斌%劉勇%劉景臣%汪學鬆%孫武%趙麗娟%邱貴興
형택군%장건국%우빈%류용%류경신%왕학송%손무%조려연%구귀흥
青少年特发性脊柱侧凸%椎弓根螺钉%远端交界区变化%后路矫形
青少年特髮性脊柱側凸%椎弓根螺釘%遠耑交界區變化%後路矯形
청소년특발성척주측철%추궁근라정%원단교계구변화%후로교형
Adolescent idiopathic scoliosis%Pedicle screw%Distal junctional changes%Posterior cprrection
目的:探讨青少年特发性脊柱侧凸(AIS)患者后路矫形术后远端交界区(LIV+2)在冠状面、矢状面和轴位上的变化.方法:2005年6月～2007年6月手术治疗AIS患者32例,男6例,女26例,年龄10～19岁,平均14.4岁.按PUMC分型,Ⅰ c 1例,Ⅱa 4例,Ⅱb1 9例,Ⅱb2 1例,Ⅱc1 1例,Ⅱc3 5例,Ⅱd1 5例,Ⅲa 5例,Ⅲb 11例.均采用后路全节段椎弓根螺钉系统矫形同定,其中远端融合椎(LIV)与稳定椎(SV)为同一椎体(A组)15例,LIV与SV非同一椎体(B组)17例.术前和末次随访时摄站立位全脊柱正侧位X线片,测量冠状面上躯干偏移(TS),LIV的倾斜度(LIVT),LIV尾侧椎间盘开角(LIVA),冠状面和矢状面上远端交界区的Cobb角和椎体的旋转度(LIV+1 VR和LIV+2 VR).结果:随访24～36个月,平均29个月.两组末次随访时的TS与术前比较均无显著性差异(P>0.05).A组LIVT由术前20.2°±5.9°下降到末次随访时的4.7°±3.8°(P<0.001),B组由17.2°±5.5°下降到4.4°±2.7°(P<0.001);A组术前和末次随访时LIVA分别为7.5°±4.7°和3.9°±3.1°(P=0.056);B组分别为4.5°±3.4°和5.4°±3.2°(P=0.492);Pearson's相关分析显示两组远端融合椎倾斜度变化和其尾侧椎间盘开角变化之间相关性不显著(A组r=-0.067,P=0.813;B组r=0.362,P=0.154).A组远端交界区(LIV+2)冠状面上Cobb角由术前20.5°±9.6°矫正至末次随访时9.4°±7.3°(P<0.001);B组由13.8°±6.7°矫正至8.1°±4.7°(P=0.013);A、B组末次随访时远端交界区矢状面上Cobb角与术前比较均无显著性差异(分别为P=0.464,P=0.598);Pearson's相关分析显示A组末次随访时矢状面Cobb角和术前矢状面Cobb角之间相关性不显著(r=0.076,P=0.788),B组的相关性显著(r=0.803,P<0.001).两组末次随访时LIV+1 VR和LIV+2 VR与术前比较均无显著性差异(P>0.05).结论:AIS患者应用后路全节段椎弓根螺钉系统矫正后远端交界区在冠状面上矫形明显,矢状面和轴位上矫形不明显,且远端融合椎倾斜度减小.
目的:探討青少年特髮性脊柱側凸(AIS)患者後路矯形術後遠耑交界區(LIV+2)在冠狀麵、矢狀麵和軸位上的變化.方法:2005年6月～2007年6月手術治療AIS患者32例,男6例,女26例,年齡10～19歲,平均14.4歲.按PUMC分型,Ⅰ c 1例,Ⅱa 4例,Ⅱb1 9例,Ⅱb2 1例,Ⅱc1 1例,Ⅱc3 5例,Ⅱd1 5例,Ⅲa 5例,Ⅲb 11例.均採用後路全節段椎弓根螺釘繫統矯形同定,其中遠耑融閤椎(LIV)與穩定椎(SV)為同一椎體(A組)15例,LIV與SV非同一椎體(B組)17例.術前和末次隨訪時攝站立位全脊柱正側位X線片,測量冠狀麵上軀榦偏移(TS),LIV的傾斜度(LIVT),LIV尾側椎間盤開角(LIVA),冠狀麵和矢狀麵上遠耑交界區的Cobb角和椎體的鏇轉度(LIV+1 VR和LIV+2 VR).結果:隨訪24～36箇月,平均29箇月.兩組末次隨訪時的TS與術前比較均無顯著性差異(P>0.05).A組LIVT由術前20.2°±5.9°下降到末次隨訪時的4.7°±3.8°(P<0.001),B組由17.2°±5.5°下降到4.4°±2.7°(P<0.001);A組術前和末次隨訪時LIVA分彆為7.5°±4.7°和3.9°±3.1°(P=0.056);B組分彆為4.5°±3.4°和5.4°±3.2°(P=0.492);Pearson's相關分析顯示兩組遠耑融閤椎傾斜度變化和其尾側椎間盤開角變化之間相關性不顯著(A組r=-0.067,P=0.813;B組r=0.362,P=0.154).A組遠耑交界區(LIV+2)冠狀麵上Cobb角由術前20.5°±9.6°矯正至末次隨訪時9.4°±7.3°(P<0.001);B組由13.8°±6.7°矯正至8.1°±4.7°(P=0.013);A、B組末次隨訪時遠耑交界區矢狀麵上Cobb角與術前比較均無顯著性差異(分彆為P=0.464,P=0.598);Pearson's相關分析顯示A組末次隨訪時矢狀麵Cobb角和術前矢狀麵Cobb角之間相關性不顯著(r=0.076,P=0.788),B組的相關性顯著(r=0.803,P<0.001).兩組末次隨訪時LIV+1 VR和LIV+2 VR與術前比較均無顯著性差異(P>0.05).結論:AIS患者應用後路全節段椎弓根螺釘繫統矯正後遠耑交界區在冠狀麵上矯形明顯,矢狀麵和軸位上矯形不明顯,且遠耑融閤椎傾斜度減小.
목적:탐토청소년특발성척주측철(AIS)환자후로교형술후원단교계구(LIV+2)재관상면、시상면화축위상적변화.방법:2005년6월～2007년6월수술치료AIS환자32례,남6례,녀26례,년령10～19세,평균14.4세.안PUMC분형,Ⅰ c 1례,Ⅱa 4례,Ⅱb1 9례,Ⅱb2 1례,Ⅱc1 1례,Ⅱc3 5례,Ⅱd1 5례,Ⅲa 5례,Ⅲb 11례.균채용후로전절단추궁근라정계통교형동정,기중원단융합추(LIV)여은정추(SV)위동일추체(A조)15례,LIV여SV비동일추체(B조)17례.술전화말차수방시섭참립위전척주정측위X선편,측량관상면상구간편이(TS),LIV적경사도(LIVT),LIV미측추간반개각(LIVA),관상면화시상면상원단교계구적Cobb각화추체적선전도(LIV+1 VR화LIV+2 VR).결과:수방24～36개월,평균29개월.량조말차수방시적TS여술전비교균무현저성차이(P>0.05).A조LIVT유술전20.2°±5.9°하강도말차수방시적4.7°±3.8°(P<0.001),B조유17.2°±5.5°하강도4.4°±2.7°(P<0.001);A조술전화말차수방시LIVA분별위7.5°±4.7°화3.9°±3.1°(P=0.056);B조분별위4.5°±3.4°화5.4°±3.2°(P=0.492);Pearson's상관분석현시량조원단융합추경사도변화화기미측추간반개각변화지간상관성불현저(A조r=-0.067,P=0.813;B조r=0.362,P=0.154).A조원단교계구(LIV+2)관상면상Cobb각유술전20.5°±9.6°교정지말차수방시9.4°±7.3°(P<0.001);B조유13.8°±6.7°교정지8.1°±4.7°(P=0.013);A、B조말차수방시원단교계구시상면상Cobb각여술전비교균무현저성차이(분별위P=0.464,P=0.598);Pearson's상관분석현시A조말차수방시시상면Cobb각화술전시상면Cobb각지간상관성불현저(r=0.076,P=0.788),B조적상관성현저(r=0.803,P<0.001).량조말차수방시LIV+1 VR화LIV+2 VR여술전비교균무현저성차이(P>0.05).결론:AIS환자응용후로전절단추궁근라정계통교정후원단교계구재관상면상교형명현,시상면화축위상교형불명현,차원단융합추경사도감소.
Objective:To investigate distal junctional changes on the coronal,saggital and axial plane in ado-lescent idiopathic scoliosis(AIS) undergoing posterior correction.Methad :32 AIS cases from June 2005 to June 2007 undergoing surgery were reviewed retrospectively.There were 6 males and 26 females with an average age of 14.4 years(range,10 to 19 years old).The curve typos included PUMC Ⅰ c 1 case, Ⅱa 4 cases, Ⅱb 9 cases, Ⅱb2 1 caze, Ⅱc1 1 case, Ⅱc3 5 cases, Ⅱd1 5 cases ,Ⅲa 5 cases, Ⅲb 1 case.All of them undergoing posterior correction using pedicle screw constructs alone were divided into 2 groups:group A, 15cases,with the lowest instrumented vertebrae(LIV) of stable vertebrae(SV)(SV=LIV);group B,17cases,with LIV of not the stable vertebrae (SV≠LIV).Radiographic measurements from standing anterio-posterior and lateral radiographs before surgery and at final follow-up including trunk shift(TS),lowest instrumented vertebrae tih(LIVT),distal disc angulation(LIVA),coronal and sagittal Cobb angle of distal juncfion(LIV+2),axial rotation of distal junc-tion(LIV+1 vertebral rotation and LIV+2 vertebral rotation) were collected and analyzed.Result:The average follow-up was 29 months(range,24 to 36 months).There were no statistic difference in TS before surgery and at final follow-up in both groups (P>0.05).The LIVT was corrected from 20.2°±5.9° before surgery to 4.7°±3.8° at final follow-up (P<0.001) in group A and 17.2°±5.5° to 4.4°±2.7°(P<0.001) in group B.The LIVA was corrected from 7.5°±4.7° before surgery to 3.9°±3.1° at final follow-up(P=0.056) in group A and 4.5°±3.4° to 5.4°±3.2°(P=0.492) in group B.The LIVA change was not significantly correlated with the change of the LIVT in both group (group A:r=-0.067,P=0.813;group B:r=0.362,P=0.154).The coronal Cobb of LIV+2 improved significantly from 20.5°±9.6° before surgery to 9.4°±7.3° at final follow-up (P<0.001) in group A and 13.8°±6.7° to 8.1°±4.7°(P=0.013) in group B.There was no significant difference in saggital curve correc-tion of LIV+2 in both groups (group A:P=-0.464,group B:P=0.598).The correlation of saggital curve correction was not significant in group A(r=0.076,P=0.788) while significant in group B(r=0.803,P<0.001).There were no significant difference of LIV+2 curve axial correction in both groups (P>0.05).Conclusion:The distal junc-tional correction for AIS due to pedicle screw fixation is more significant on the coronal plane rather than the sagittal plane and axial plane,meanwhile the lowest instrumented vertebrae tilt is decreased after surgery.
