【摘要】：目的:研究重度僵硬性脊柱側(cè)凸術(shù)后遠(yuǎn)端疊加現(xiàn)象的相關(guān)危險因素及其影響。方法:2008年1月至2013年12月,回顧性分析我院行單純后路螺釘內(nèi)固定矯形術(shù)的重度僵硬性脊柱側(cè)凸患者的術(shù)前、術(shù)后、隨訪≥2年的影像學(xué)資料和臨床資料。根據(jù)隨訪結(jié)果將患者分為遠(yuǎn)端疊加現(xiàn)象陽性組和陰性組,使用單因素方差分析或卡方檢驗對兩組患者的多個危險因素進(jìn)行對比分析,得出有統(tǒng)計學(xué)差異的相關(guān)危險因素,然后用logistic回歸分析方法檢出重度僵硬性脊柱側(cè)凸術(shù)后遠(yuǎn)端疊加現(xiàn)象的獨立危險因素。結(jié)果:符合納入標(biāo)準(zhǔn)且獲得完整隨訪資料的患者共48例。所有患者均隨訪24月及以上,平均隨訪時間34.7(24~52)月�；颊叩钠骄餍貜滳obb角和主胸彎柔韌性分別為107.4°±15.9°、16.4%±10.2%。隨訪結(jié)果顯示其中12(25%)例患者出現(xiàn)術(shù)后遠(yuǎn)端疊加現(xiàn)象。患者的年齡、Risser征、主胸彎柔韌度與術(shù)后遠(yuǎn)端疊加現(xiàn)象的相關(guān)性有統(tǒng)計學(xué)意義;患者術(shù)后資料中與遠(yuǎn)端疊加現(xiàn)象的相關(guān)性有統(tǒng)計學(xué)意義的危險因素有:術(shù)后主胸彎Cobb角、主胸彎矯正率、腰彎矯正率、融合節(jié)段長度、主胸彎頂椎偏移度、術(shù)后下端固定椎傾斜角,下端固定椎與下端椎、穩(wěn)定椎、偏移椎、最后觸及椎、最后實質(zhì)觸及椎之間的椎體節(jié)段差;患者隨訪資料中與遠(yuǎn)端疊加現(xiàn)象的相關(guān)性有統(tǒng)計學(xué)意義的危險因素有:隨訪主胸彎Cobb角、主胸彎矯正率、主胸彎頂椎偏移距離、下端固定椎傾斜角;另外,術(shù)后主胸彎頂椎偏移度較術(shù)前變化值、術(shù)后下端固定椎到骶正中線距離較術(shù)前變化值、隨訪下端固定椎到骶正中線距離較術(shù)后變化值與術(shù)后遠(yuǎn)端疊加現(xiàn)象的相關(guān)性有統(tǒng)計學(xué)意義。logistic回歸分析顯示主胸彎矯正率(OR:1.107,95%CI:1.024—1.197,P=0.011)和下端固定椎與最后觸及椎椎體節(jié)段差(OR:0.121,95%CI:0.028—0.518,P=0.004)是重度僵硬性脊柱側(cè)凸術(shù)后遠(yuǎn)端疊加現(xiàn)象的兩個獨立危險因素。結(jié)論:較高的主胸彎矯正率和下端固定椎選擇高于最后觸及椎與重度僵硬性脊柱側(cè)凸術(shù)后遠(yuǎn)端疊加現(xiàn)象的發(fā)生密切相關(guān)。
[Abstract]:Objective: to study the risk factors and influence of distal superposition after severe stiff scoliosis. Methods: from January 2008 to December 2013, the preoperative and postoperative imaging data and clinical data of patients with severe rigid scoliosis undergoing simple posterior screw fixation were retrospectively analyzed. According to the follow-up results, the patients were divided into two groups: positive group and negative group. Univariate ANOVA or chi-square test were used to compare and analyze the risk factors of the two groups. Then logistic regression analysis was used to detect the independent risk factors of distal superposition after severe stiff scoliosis. Results: a total of 48 patients met the inclusion criteria and obtained complete follow-up data. All patients were followed up for 24 months or more, with an average follow-up time of 34.7 (24 / 52) months. The mean Cobb angle and flexibility of the main thoracic curvature were 107.4 擄鹵15.9 擄and 16.4% 鹵10.2%, respectively. Follow-up results showed that 12 (25%) of the patients had postoperative distal superposition. Risser's sign, flexibility of main thoracic bending and distal superposition were significantly correlated with the postoperative data, and the risk factors of the correlation were: Cobb angle of the main thoracic curvature after operation, and the correlation between the data of the patients and the distal superposition of the patients after the operation, and the risk factors of the patients were as follows: the cob angle of the main thoracic curvature after operation. The correction rate of the main thoracic curvature, the correction rate of the lumbar curve, the length of the fusion segment, the deviation degree of the main thoracic curved top vertebra, the fixation of the inclination angle of the lower end of the vertebra, the fixation of the lower end of the vertebra and the lower end of the vertebra, the stabilization of the vertebra, the deviation of the vertebrae, and finally The risk factors associated with distal superposition in the follow-up data were: Cobb angle of the main thoracic curvature, correction rate of the main thoracic curvature, deviation distance of the top vertebra of the main thoracic curvature. The angle of inclination was fixed at the lower end of the vertebra, in addition, the deviation of the main thoracic curvature was higher than that of the preoperative, and the distance from the lower end of the fixation to the median sacral line was higher than that before the operation. Logistic regression analysis showed that the correction rate of principal thoracic curvature (OR: 1.107 ~ 95CI: 1.024-1.197 P0.011) and the fixation of the lower end of the vertebra and the final touch of vertebral body segment were significantly higher than those of the postoperatively fixed vertebrae and the distal superposition of the distal end of the vertebrae (OR: 1.107 ~ 95CI: 1.024-1.197 P0.011). The segmental difference (OR: 0.121 / 95) is two independent risk factors for the distal superposition after severe stiff scoliosis (CI: 0.028-0.518 P0.004). Conclusion: the higher correction rate of main thoracic curvature and the choice of lower end fixation are higher than those of the last touch vertebrae and the distal superposition of severe stiff scoliosis.
【學(xué)位授予單位】：首都醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3

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相關(guān)期刊論文 前1條

1 ;Posterior Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis Patients:a Comparison of All Pedicle Screws versus Hybrid Instrumentation[J];Chinese Medical Sciences Journal;2009年01期

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本文編號：2122638