CAJ | 학술논문

目的：探讨下端融合椎（lowest instrumented vertebra，LIV）相关影像学指标对Lenke 5C型特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者术后冠状面平衡的影响。方法：本研究包括30例行后路选择性融合的Lenke 5C型AIS患者，所有患者于术前、术后即刻及末次随访时拍摄站立前后位像及术前仰卧位拍摄左右Bending像。对术前、术后和末次随访时的冠状面平衡与LIV相关影像学指标（LIV偏移、LIV旋转、LIV倾斜度、LIV尾侧椎间盘开角）进行分析。结果：所有患者平均随访33个月（24~50个月），其中LIV为L3者20例， L4者10例。30例Lenke 5C型AIS患者术前冠状面胸腰弯/腰弯Cobb角平均为49.8°±5.1°，术前冠状面胸弯Cobb角平均为25.6°±7.1°。相关性检验发现以下3个指标与术后即刻冠状面平衡（coronal trunk balance，CTB）有显著相关性：（1）术前CTB（r=0.69，r2=0.48，P<0.01）；（2）术前LIV倾斜度（r=0.63，r2=0.40，P<0.01）；（3）术后即刻LIV倾斜度（r=0.60，r2=0.36，P<0.01）。在末次随访时，不管是术前还是术后的LIV相关影像学指标均与末次随访时CTB无显著相关（P>0.05）。结论：对行后路选择性融合术的Lenke 5C型AIS患者而言，术前冠状面平衡与否及术前LIV倾斜度大小对预测术后即刻冠状面平衡有重要的作用。术前LIV倾斜大于25°的患者容易发生术后即刻冠状面失平衡。然而，LIV倾斜度对Lenke 5C型AIS患者术后冠状面平衡无显著影响。
목적：탐토하단융합추（lowest instrumented vertebra，LIV）상관영상학지표대Lenke 5C형특발성척주측철（adolescent idiopathic scoliosis，AIS）환자술후관상면평형적영향。방법：본연구포괄30례행후로선택성융합적Lenke 5C형AIS환자，소유환자우술전、술후즉각급말차수방시박섭참립전후위상급술전앙와위박섭좌우Bending상。대술전、술후화말차수방시적관상면평형여LIV상관영상학지표（LIV편이、LIV선전、LIV경사도、LIV미측추간반개각）진행분석。결과：소유환자평균수방33개월（24~50개월），기중LIV위L3자20례， L4자10례。30례Lenke 5C형AIS환자술전관상면흉요만/요만Cobb각평균위49.8°±5.1°，술전관상면흉만Cobb각평균위25.6°±7.1°。상관성검험발현이하3개지표여술후즉각관상면평형（coronal trunk balance，CTB）유현저상관성：（1）술전CTB（r=0.69，r2=0.48，P<0.01）；（2）술전LIV경사도（r=0.63，r2=0.40，P<0.01）；（3）술후즉각LIV경사도（r=0.60，r2=0.36，P<0.01）。재말차수방시，불관시술전환시술후적LIV상관영상학지표균여말차수방시CTB무현저상관（P>0.05）。결론：대행후로선택성융합술적Lenke 5C형AIS환자이언，술전관상면평형여부급술전LIV경사도대소대예측술후즉각관상면평형유중요적작용。술전LIV경사대우25°적환자용역발생술후즉각관상면실평형。연이，LIV경사도대Lenke 5C형AIS환자술후관상면평형무현저영향。
Objectives: To investigate the long-term effect of radiographic parameters associated with the low-est instrumented vertebrae (LIV) on postoperative coronal trunk balance in adolescent idiopathic scoliosis (AIS) patients with type Lenke 5 curve. Methods: In this retrospective study, totally 30 AIS patients with type Lenke 5 curve who received posterior selective fusion were included. Pre- and postoperative standing upright posteroanterior and lateral radiographs as well as preoperative supine left and right side-bending radiographs were used for radiographic assessment. Bivariate correlation tests were carried on to analyze the correlation of each radiographic parameter related to the LIV and the coronal trunk balance immediately after surgery and at final follow-up. Results: The average follow-up time was 33 months(range 24-50 months). The LIV was L3(n=20) or L4(n=10). The average preoperative Cobb angle of the TL/L curve and thoracic curve was 49.8°± 5.1° and 25.6°±7.1°, respectively. Correlation analysis showed that the following radiographic parameters were significantly associated with the immediate postoperative coronal trunk balance(CTB): preoperative coronal trunk balance(r=0.69, r2=0.48, P<0.01), preoperative LIV tilt(r=0.63, r2=0.40, P<0.01), and postoperative LIV tilt(r=0.60, r2=0.36, P<0.01). However, at final follow-up, neither preoperative nor postoperative parameters were as-sociated with the final coronal trunk balance(P>0.05). Conclusions: In AIS patients with type Lenke 5 curve, preoperative coronal trunk balance and preoperative LIV tilt are very important parameters in predicting the immediate postoperative coronal trunk balance. Preoperative LIV tilt ≥25° is associated with a high risk of developing immediate postoperative coronal imbalance. During the follow-up, no radiographic parameters at either preoperation or postoperation have statistical correlation with the final coronal trunk balance.