CAJ | 학술논문

目的探讨青少年Chiari畸形伴胸椎侧凸不同远端固定节段的选择对手术疗效的影响.方法后路选择性胸椎融合术且随访超过2年的青少年共27例,男11例,女16例；年龄为12～18岁,平均15.2岁.记录术前、术后以及末次随访时的临床资料及影像学指标:冠状面侧凸Cobb角、侧凸柔韧性、顶椎偏移(apical vertebral translation,AVT)、顶椎旋转(apical vertebral rotation,AVR)及躯干偏移；矢状面胸椎后凸角(thoracic kyphosis,TK)、胸腰段Cobb角(thoracolumbar kyphosis,TLK)、腰椎前凸角(lumbar lordosis,LL)及躯干偏移(sagittal vertical axis,SVA),并进行统计学分析.结果随访时间2～7年,平均3.4年.末次随访时的胸弯矫正率为55.9％,矫正丢失率2.3％,腰弯自发矫正率为59.2％.术前腰弯修正为A型与B型两组患者末次随访时各项影像学指标的差异均无统计学意义.除腰弯修正为B型且远端固定椎为L1的病例末次随访时的平均LL(59.8°)明显大于L2者(40.8°)外,A型及B型病例中远端固定椎位于L1或L2者其他各项影像学指标的差异均无统计学意义.结论术前腰弯修正为A型及B型的青少年Chiari畸形伴胸椎侧凸患者采用后路选择性胸椎融合术治疗,可获得满意的胸弯矫正及腰弯的自发性矫正.
목적 탐토청소년Chiari기형반흉추측철불동원단고정절단적선택대수술료효적영향.방법 후로선택성흉추융합술차수방초과2년적청소년공27례,남11례,녀16례；년령위12～18세,평균15.2세.기록술전、술후이급말차수방시적림상자료급영상학지표:관상면측철Cobb각、측철유인성、정추편이(apical vertebral translation,AVT)、정추선전(apical vertebral rotation,AVR)급구간편이；시상면흉추후철각(thoracic kyphosis,TK)、흉요단Cobb각(thoracolumbar kyphosis,TLK)、요추전철각(lumbar lordosis,LL)급구간편이(sagittal vertical axis,SVA),병진행통계학분석.결과 수방시간2～7년,평균3.4년.말차수방시적흉만교정솔위55.9％,교정주실솔2.3％,요만자발교정솔위59.2％.술전요만수정위A형여B형량조환자말차수방시각항영상학지표적차이균무통계학의의.제요만수정위B형차원단고정추위L1적병례말차수방시적평균LL(59.8°)명현대우L2자(40.8°)외,A형급B형병례중원단고정추위우L1혹L2자기타각항영상학지표적차이균무통계학의의.결론 술전요만수정위A형급B형적청소년Chiari기형반흉추측철환자채용후로선택성흉추융합술치료,가획득만의적흉만교정급요만적자발성교정.
Objective To investigate the effect of lowest instrumented vertebrae (LIV) selection on clinical outcome of posterior thoracic fusion in adolescents with thoracic scoliosis secondary to Chiari malformation.Methods A total of 27 adolescents with Chiari malformation-associated scoliosis,who had undergone posterior thoracic fusion and been followed up for at least 2 years,were enrolled in this study.There were 11 males and 16 females,with an average age of 15.2 years (range,12 to 18 years).The following radiographic parameters:coronal Cobb angle,curve flexibility,apical vertebral translation (AVT),apical vertebral rotation (AVR),trunk shift (C7PL-CSVL distance),thoracic kyphosis (TK),lumbar lordosis (LL),thoracolumbar kyphosis,and sagittal vertical axis (SVA) were recorded preoperatively,immediately after surgery and at the last follow-up.Results All the patients received a followed-up from 2 to 7 years (average,3.4years).At the last follow-up,the average correction rate of thoracic curve was 55.9％ with an average correction loss rate of 2.3％.The spontaneous correction rate of lumbar curve was 59.2％ on average.At the last follow-up,no significant difference in terms of the radiographic parameters was found between patients with lumbar modifier "A" and "B".In patients having the lumbar modifier "A",the LIV was at L1 in 6 cases and at L2 in 7 cases.As for those with lumbar modifier "B",the LIV located at L1 in 6 cases,L2 in 4 cases,and T12 in 1 case.Among patients with lumbar modifier "B",the LL was significantly higher in cases with LIV at L1 when compared with those with LIV at L2.Conclusion Selective thoracic fusion can provide a satisfactory outcome in adolescents with Chiari malformation-associated scoliosis with lumbar modifier "A" and "B".