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
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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LIVRisser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(P>0.05)。术后随访24~69个月,共有13例患者发生DJK,发生率为8.4%,LIV0.05),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(P<0.05)。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。
Objectives:To investigate the influence of relationship between lowest instrumented vertebra(LIV)and sagittal stable vertebra(SSV) on the occurrence of distal junctional kyphosis(DJK) after posterior selective fusion in Lenke 1A scoliosis. Methods:A consecutive cohort of 153 patients with Lenke 1A scoliosis who had undergone posterior selective thoracic fusion was reviewed. SSV was defined as the last vertebra with in-ferior endplate touched by the posterior sacrum vertical line. According to the relationship between SSV and LIV, the patients were divided into two groups:LIV
Objectives:To investigate the influence of relationship between lowest instrumented vertebra(LIV)and sagittal stable vertebra(SSV) on the occurrence of distal junctional kyphosis(DJK) after posterior selective fusion in Lenke 1A scoliosis. Methods:A consecutive cohort of 153 patients with Lenke 1A scoliosis who had undergone posterior selective thoracic fusion was reviewed. SSV was defined as the last vertebra with in-ferior endplate touched by the posterior sacrum vertical line. According to the relationship between SSV and LIV, the patients were divided into two groups:LIV
引文
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2.Zhang Y,Lin G,Zhang J,et al.Radiographic evaluation o posterior selective thoracolumbar or lumbar fusion for moderate Lenke 5C curves[J].Arch Orthop Trauma Surg,2017,137(1):1-8.
3.邱贵兴,徐宏光,王以朋,等.青少年特发性脊柱侧凸术后失代偿原因分析及处理[J].中华骨科杂志,2003,23(7):414-417.
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5.孙旭,邱勇,孙超,等.特发性胸椎侧凸选择性融合术后远端叠加现象[J].中国脊柱脊髓杂志,2013,23(2):103-108.
6.Qin X,Sun W,Xu L,et al.Selecting the last"substantially"touching vertebra as lowest instrumented vertebra in Lenke type 1A curve:radiographic outcomes with a minimum of 2-year follow-Up[J].Spine(Phila Pa 1976),2016 41(12):E742-750.
7.Matsumoto M,Watanabe K,Hosogane N,et al.Postoperative distal adding-on and related factors in Lenke type 1A curve[J].Spine(Phila Pa 1976),2013,38(9):737-744.
8.Qiu Y,Zhu F,Wang B,et al.Comparison of surgical outcomes of lenke type 1 idiopathic scoliosis:vertebral coplana alignment versus derotation technique[J].J Spinal Disord Tech,2011,24(8):492-499.
9.丁旗,邱勇,孙旭,等.主胸腰弯或腰弯型青少年特发性脊柱侧凸行前路选择性融合术后胸弯失代偿的危险因素[J].中华外科杂志,2012,50(6):518-523
10.Richards BS,Birch JG,Herring JA,et al.Frontal plane and sagittal plane balance following Cotrel-Dubousset instrumen tation for idiopathic scoliosis[J].Spine(Phila Pa 1976),198914(7):733-737.
11.邱勇,夏才伟,王斌,等.青少年特发性胸椎侧凸选择性融合术后的远端交界性后凸[J].中华骨科杂志,2009,29(2)117-122.
12.Kim YJ,Lenke LG,Cho SK,et al.Comparative analysis o pedicle screw versus hook instrumentation in posterior spina fusion of adolescent idiopathic scoliosis[J].Spine(Phila Pa1976),2004,29(18):2040-2048.
13.Lowe TG,Lenke L,Betz R,et al.Distal junctional kyphosi of adolescent idiopathic thoracic curves following anterior o posterior instrumented fusion:incidence,risk factors,and prevention[J].Spine(Phila Pa 1976),2006,31(3):299-302.
14.Cho KJ,Lenke LG,Bridwell KH,et al.Selection of the optimal distal fusion level in posterior instrumentation and fu sion for thoracic hyperkyphosis:the sagittal stable vertebra concept[J].Spine(Phila Pa 1976),2009,34(8):765-770.
15.Glattes RC,Bridwell KH,Lenke LG,et al.Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion:incidence,outcomes,and risk factor analysis[J].Spine(Phila Pa 1976),2005,30(14)1643-1649.
16.Suk SI,Lee SM,Chung ER,et al.Selective thoracic fusion with segmental pedicle screw fixation in the treatment o thoracic idiopathic scoliosis:more than 5-year follow-up[J]Spine(Phila Pa 1976),2005,30(14):1602-1609.
17.Rhee JM,Bridwell KH,Won DS,et al.Sagittal plane analysis of adolescent idiopathic scoliosis:the effect of anterio versus posterior instrumentation[J].Spine(Phila Pa 1976)2002,27(21):2350-2356.
18.Mc Cance SE,Denis F,Lonstein JE,et al.Coronal and sagittal balance in surgically treated adolescent idiopathic scoliosis with the King II curve pattern:a review of 67consecutive cases having selective thoracic arthrodesis[J].Spine(Phila Pa 1976),1998,23(19):2063-2073.
19.Cho SK,Kim YJ,Lenke LG.proximal junctional kyphosi following spinal deformity surgery in the pediatric patient[J]J Am Acad Orthop Surg,2015,23(7):408-14.
20.Lundine K,Turner P,Johnson M,et al.Thoracic hyperkyphosis:assessment of the distal fusion level[J].Globa Spine J,2012,2(2):65-70.
21.刘臻,邱勇,朱泽章,等.Lenke 1型特发性脊柱侧凸选择性胸弯融合时的下端融合椎选择:T12还是L1[J].中国矫形外科杂志,2012,20(21):1921-1925.
22.Yanik HS,Ketenci IE,Coskun T,et al.Selection of dista fusion level in posterior instrumentation and fusion o Scheuermann kyphosis:is fusion to sagittal stable vertebra necessary[J].Eur Spine J,2016,25(2):583-589.
2.Zhang Y,Lin G,Zhang J,et al.Radiographic evaluation o posterior selective thoracolumbar or lumbar fusion for moderate Lenke 5C curves[J].Arch Orthop Trauma Surg,2017,137(1):1-8.
3.邱贵兴,徐宏光,王以朋,等.青少年特发性脊柱侧凸术后失代偿原因分析及处理[J].中华骨科杂志,2003,23(7):414-417.
4.Cho RH,Yaszay B,Bartley CE,et al.Which Lenke 1Acurves are at the greatest risk for adding-on...and why[J]Spine(Phila Pa 1976),2012,37(16):1384-1390.
5.孙旭,邱勇,孙超,等.特发性胸椎侧凸选择性融合术后远端叠加现象[J].中国脊柱脊髓杂志,2013,23(2):103-108.
6.Qin X,Sun W,Xu L,et al.Selecting the last"substantially"touching vertebra as lowest instrumented vertebra in Lenke type 1A curve:radiographic outcomes with a minimum of 2-year follow-Up[J].Spine(Phila Pa 1976),2016 41(12):E742-750.
7.Matsumoto M,Watanabe K,Hosogane N,et al.Postoperative distal adding-on and related factors in Lenke type 1A curve[J].Spine(Phila Pa 1976),2013,38(9):737-744.
8.Qiu Y,Zhu F,Wang B,et al.Comparison of surgical outcomes of lenke type 1 idiopathic scoliosis:vertebral coplana alignment versus derotation technique[J].J Spinal Disord Tech,2011,24(8):492-499.
9.丁旗,邱勇,孙旭,等.主胸腰弯或腰弯型青少年特发性脊柱侧凸行前路选择性融合术后胸弯失代偿的危险因素[J].中华外科杂志,2012,50(6):518-523
10.Richards BS,Birch JG,Herring JA,et al.Frontal plane and sagittal plane balance following Cotrel-Dubousset instrumen tation for idiopathic scoliosis[J].Spine(Phila Pa 1976),198914(7):733-737.
11.邱勇,夏才伟,王斌,等.青少年特发性胸椎侧凸选择性融合术后的远端交界性后凸[J].中华骨科杂志,2009,29(2)117-122.
12.Kim YJ,Lenke LG,Cho SK,et al.Comparative analysis o pedicle screw versus hook instrumentation in posterior spina fusion of adolescent idiopathic scoliosis[J].Spine(Phila Pa1976),2004,29(18):2040-2048.
13.Lowe TG,Lenke L,Betz R,et al.Distal junctional kyphosi of adolescent idiopathic thoracic curves following anterior o posterior instrumented fusion:incidence,risk factors,and prevention[J].Spine(Phila Pa 1976),2006,31(3):299-302.
14.Cho KJ,Lenke LG,Bridwell KH,et al.Selection of the optimal distal fusion level in posterior instrumentation and fu sion for thoracic hyperkyphosis:the sagittal stable vertebra concept[J].Spine(Phila Pa 1976),2009,34(8):765-770.
15.Glattes RC,Bridwell KH,Lenke LG,et al.Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion:incidence,outcomes,and risk factor analysis[J].Spine(Phila Pa 1976),2005,30(14)1643-1649.
16.Suk SI,Lee SM,Chung ER,et al.Selective thoracic fusion with segmental pedicle screw fixation in the treatment o thoracic idiopathic scoliosis:more than 5-year follow-up[J]Spine(Phila Pa 1976),2005,30(14):1602-1609.
17.Rhee JM,Bridwell KH,Won DS,et al.Sagittal plane analysis of adolescent idiopathic scoliosis:the effect of anterio versus posterior instrumentation[J].Spine(Phila Pa 1976)2002,27(21):2350-2356.
18.Mc Cance SE,Denis F,Lonstein JE,et al.Coronal and sagittal balance in surgically treated adolescent idiopathic scoliosis with the King II curve pattern:a review of 67consecutive cases having selective thoracic arthrodesis[J].Spine(Phila Pa 1976),1998,23(19):2063-2073.
19.Cho SK,Kim YJ,Lenke LG.proximal junctional kyphosi following spinal deformity surgery in the pediatric patient[J]J Am Acad Orthop Surg,2015,23(7):408-14.
20.Lundine K,Turner P,Johnson M,et al.Thoracic hyperkyphosis:assessment of the distal fusion level[J].Globa Spine J,2012,2(2):65-70.
21.刘臻,邱勇,朱泽章,等.Lenke 1型特发性脊柱侧凸选择性胸弯融合时的下端融合椎选择:T12还是L1[J].中国矫形外科杂志,2012,20(21):1921-1925.
22.Yanik HS,Ketenci IE,Coskun T,et al.Selection of dista fusion level in posterior instrumentation and fusion o Scheuermann kyphosis:is fusion to sagittal stable vertebra necessary[J].Eur Spine J,2016,25(2):583-589.