远端固定椎-矢状面稳定椎位置关系对特发性胸椎侧凸矫形术后远端交界性后凸发生率的影响

发布时间：2018-09-01 13:48

【摘要】：目的:探讨远端固定椎(lowest instrumented vertebra,LIV)和矢状面稳定椎(sagittal stable vertebra,SSV)位置关系对特发性脊柱侧凸患者后路矫形选择性胸弯融合术后远端交界性后凸(distal junctional kyphosis,DJK)发生率的影响。方法:回顾性分析153例行后路主胸弯选择性融合术的Leneke 1A型青少年特发性脊柱侧凸(AIS)患者的临床资料。SSV定义为骶骨后上角垂线接触的最远端下终板所在的椎体。根据术后远端固定椎(lowest instrumented vertebra,LIV)与SSV的关系分为两组:LIV位于SSV近端椎体为LIVSSV组,LIV位于SSV或其远端椎体为LIV≥SSV组。测量患者术前、术后和随访时的冠状面主弯Cobb角和脊柱-骨盆矢状面相关参数,比较两组患者术后DJK的发生率以及发生DJK与未发生DJK患者的影像学参数和SRS-22评分。结果:LIVSSV组31例,LIV≥SSV组122例,两组患者在性别、年龄、Risser征、手术时间、手术出血量、融合节段数、随访时间、术前影像学参数及SRS-22评分均无统计学差异(P0.05)。术后随访24~69个月,共有13例患者发生DJK,发生率为8.4%,LIVSSV组患者DJK发生率(25.8%)高于LIV≥SSV组(4.1%)(χ~2=12.320,P0.001)。发生DJK患者与未发生DJK患者术前影像学参数及SRS-22评分均无显著性差异(P0.05),但末次随访时,发生DJK患者的胸椎后凸角、胸腰段后凸角、矢状面轴向距离、远端交界角均高于未发生DJK患者,且SRS-22疼痛评分低于未发生DJK患者,差异均有统计学意义(P0.05)。结论:远端固定椎-矢状面稳定椎位置关系显著影响Lenke 1A型AIS患者术后DJK的发生率,远端融合至SSV或其远端椎体可以显著降低术后DJK的发生率,更好地维持矢状面平衡。
[Abstract]:Objective: to investigate the effect of distal fixation (lowest instrumented vertebra,LIV) and sagittal stable vertebra (sagittal stable vertebra,SSV) position on the incidence of distal borderline kyphosis (distal junctional kyphosis,DJK) in patients with idiopathic scoliosis. Methods: the clinical data of 153 patients with Leneke 1A adolescent idiopathic scoliosis (AIS) who underwent selective posterior thoracic curvature fusion were analyzed retrospectively. According to the relationship between (lowest instrumented vertebra,LIV and SSV, the patients were divided into two groups: one group was located at the proximal end of SSV, the other was LIVSSV group, or the distal vertebral body was LIV 鈮，

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