Lenke 5C 青少年特发性脊柱侧凸术后冠状不平衡:演变、风险因素和临床意义。

IF 3.8 2区 医学 Q1 CLINICAL NEUROLOGY Neurospine Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI:10.14245/ns.2448544.272
Yinyu Fang, Jie Li, Zongshan Hu, Zezhang Zhu, Yong Qiu, Zhen Liu
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引用次数: 0

摘要

目的探讨Lenke 5C青少年特发性脊柱侧凸(AIS)在后路选择性融合手术后冠状面不平衡(CIB)的变化,并确定其对手术决策的影响:120例患者根据术前冠状面形态(A型、冠状面平衡距离[CBD])进行分类:与A型患者相比,C型患者术后CIB的发生率更高(22%对38%,p):AIS 中的 C 型 CIB 患者的恢复效果并不理想,其中 29% 的患者在最终随访时仍有 CIB。近端Cobb-1的选择性融合策略可降低术后CIB的风险,尤其是当术前冠状形态为C型时。
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Postoperative Coronal Imbalance in Lenke 5C Adolescent Idiopathic Scoliosis: Evolution, Risk Factors, and Clinical Implications.

Objective: To explore the changes in coronal imbalance (CIB) in Lenke 5C adolescent idiopathic scoliosis (AIS) after posterior selective fusion surgery and determine their implications for surgical decision-making.

Methods: One hundred twenty patients were categorized according to the preoperative coronal pattern (type A, coronal balance distance [CBD]<20 mm; type B, CBD≥20 mm and coronal C7 plumbline [C7PL] shifted to the concave side of the curve; type C, CBD≥20 mm and C7PL shifted to the convex side of the curve). CIB group (CIB+) was defined as having a CBD≥20 mm at the 2-year follow-up.

Results: Compared to type A patients, the prevalence of postoperative CIB was higher in type C patients both immediately postoperative (22% vs. 38%, p<0.05) and at the final follow-up (5% vs. 29%, p<0.05), whereas type A patients showed a greater improvement in CBD (9 of 12 vs. 6 of 24, p<0.05) at the final follow-up. The majority of patients in all groups had recovered to type A at the final follow-up (96 of 120). The proximal Cobb-1 strategy reduced the incidence of postoperative CIB (1 of 38) at the 2-year follow-up, especially in preoperative type C patients. Multivariate logistic regression analysis revealed that type C and overcorrection of the thoracolumbar curve were risk factors for CIB at the 2-year follow-up (p=0.007 and p=0.026, respectively).

Conclusion: Patients with type C CIB in AIS exhibited unsatisfactory restoration, with 29% of them exhibiting CIB at the final follow-up. The selective fusion strategy of proximal Cobb-1 may reduce the risk of postoperative CIB especially when the preoperative coronal pattern is type C.

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来源期刊
Neurospine
Neurospine Multiple-
CiteScore
5.80
自引率
18.80%
发文量
93
审稿时长
10 weeks
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