Risk Factors for Postoperative Shoulder Imbalance in Patients with Lenke Type 1 and 2 Scoliosis Treated using the Vertebral Coplanar Alignment Technique.

IF 2.6 2区医学 Q2 CLINICAL NEUROLOGY Spine Pub Date : 2024-10-31 DOI:10.1097/BRS.0000000000005171

Arihisa Shimura, Hidetoshi Nojiri, Muneaki Ishijima, Hiroshi Moridaira, Hidekazu Arai, Satoshi Takada, Katsutaka Yamada, Naoya Kondo, Tadao Morino, Eiichiro Nakamura, Masaki Tomori, Kazuyuki Otani, Koji Akeda, Takuya Nagai, Hiromitsu Toyoda, Kenyu Ito, Junya Katayanagi, Hiroshi Taneichi

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Abstract

Study design: This was a multicenter retrospective cohort study.

Objective: We investigated the incidence of postoperative shoulder imbalance (PSI) and its risk factors in patients with Lenke types 1 and 2 scoliosis corrected using vertebral coplanar alignment (VCA).

Summary of background data: PSI in scoliosis affects patient quality of life. While other correction methods have reported a high correction rate for the main thoracic curve (MTC) in relation to PSI, this correlation has not been confirmed for the VCA technique.

Methods: We studied 176 patients with Lenke types 1 and 2 scoliosis who underwent posterior corrective fusion surgery using the VCA technique at 11 institutions. At two years postoperatively, patients were divided into two groups based on radiographic shoulder height (RSH): PSI- (RSH<2 cm) and PSI+ (RSH≧2 cm) groups. We analyzed the risk factors for PSI.

Results: The overall incidence of PSI two years postoperatively was 11.4% (20/176), with 9.2% (11/119) and 15.8% (9/57) in patients with Lenke types 1 and 2, respectively. Contrary to a previous study, a high MTC correction rate did not emerge as a risk factor for PSI. Instead, preoperative left shoulder elevation and low postoperative thoracic kyphosis and greater T1 tilt and high apical vertebral body-to-rib ratio were associated with PSI in patients with Lenke type 1. Preoperative left shoulder elevation and a low postoperative proximal thoracic curve (PTC) correction rate were identified as risk factors for PSI in patients with Lenke type 2.

Conclusion: Our results suggest that proper correction of the PTC, rather than compromise MTC correction, may help prevent PSI in the VCA technique. This method is particularly advantageous for addressing Lenke type 1 scoliosis and yields favorable outcomes in shoulder balance. Patients with preoperative left shoulder elevation, especially Lenke type 2, are at high risk of developing PSI.

Level of evidence: 4.

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使用椎体共面对齐技术治疗伦克1型和2型脊柱侧凸患者术后肩部不平衡的风险因素。

研究设计这是一项多中心回顾性队列研究：我们调查了使用椎体共面对位（VCA）矫正的伦克1型和2型脊柱侧凸患者术后肩关节不平衡（PSI）的发生率及其风险因素：脊柱侧弯症的PSI影响患者的生活质量。尽管其他矫正方法报告称主胸廓曲线（MTC）的高矫正率与PSI有关，但VCA技术的这种相关性尚未得到证实：我们研究了在 11 家医疗机构接受 VCA 技术后路矫正融合手术的 176 名 Lenke 1 型和 2 型脊柱侧凸患者。术后两年，根据影像学肩高（RSH）将患者分为两组：PSI-（RSHR结果：术后两年 PSI 的总发生率为 11.4%（20/176），其中伦克 1 型和 2 型患者的发生率分别为 9.2%（11/119）和 15.8%（9/57）。与之前的研究相反，MTC矫正率高并不是PSI的风险因素。相反，术前左肩抬高、术后胸椎后凸程度低、T1倾斜程度大以及椎体顶端与肋骨比率高与Lenke 1型患者的PSI相关。在 Lenke 2 型患者中，术前左肩抬高和术后近端胸廓曲线（PTC）矫正率低被认为是 PSI 的风险因素：我们的研究结果表明，在 VCA 技术中，适当的 PTC 矫正而非妥协的 MTC 矫正有助于预防 PSI。这种方法对于解决伦克1型脊柱侧凸尤为有利，并能获得良好的肩部平衡效果。术前左肩抬高的患者，尤其是 Lenke 2 型患者，患 PSI 的风险很高：4.

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Spine 医学-临床神经学

CiteScore

5.90

自引率

6.70%

发文量

361

审稿时长

6.0 months

期刊介绍： Lippincott Williams & Wilkins is a leading international publisher of professional health information for physicians, nurses, specialized clinicians and students. For a complete listing of titles currently published by Lippincott Williams & Wilkins and detailed information about print, online, and other offerings, please visit the LWW Online Store. Recognized internationally as the leading journal in its field, Spine is an international, peer-reviewed, bi-weekly periodical that considers for publication original articles in the field of Spine. It is the leading subspecialty journal for the treatment of spinal disorders. Only original papers are considered for publication with the understanding that they are contributed solely to Spine. The Journal does not publish articles reporting material that has been reported at length elsewhere.