【摘要】：目的:探討遠(yuǎn)端固定椎(lowest instrumented vertebra,LIV)和矢狀面穩(wěn)定椎(sagittal stable vertebra,SSV)位置關(guān)系對(duì)特發(fā)性脊柱側(cè)凸患者后路矯形選擇性胸彎融合術(shù)后遠(yuǎn)端交界性后凸(distal junctional kyphosis,DJK)發(fā)生率的影響。方法:回顧性分析153例行后路主胸彎選擇性融合術(shù)的Leneke 1A型青少年特發(fā)性脊柱側(cè)凸(AIS)患者的臨床資料。SSV定義為骶骨后上角垂線接觸的最遠(yuǎn)端下終板所在的椎體。根據(jù)術(shù)后遠(yuǎn)端固定椎(lowest instrumented vertebra,LIV)與SSV的關(guān)系分為兩組:LIV位于SSV近端椎體為L(zhǎng)IVSSV組,LIV位于SSV或其遠(yuǎn)端椎體為L(zhǎng)IV≥SSV組。測(cè)量患者術(shù)前、術(shù)后和隨訪時(shí)的冠狀面主彎Cobb角和脊柱-骨盆矢狀面相關(guān)參數(shù),比較兩組患者術(shù)后DJK的發(fā)生率以及發(fā)生DJK與未發(fā)生DJK患者的影像學(xué)參數(shù)和SRS-22評(píng)分。結(jié)果:LIVSSV組31例,LIV≥SSV組122例,兩組患者在性別、年齡、Risser征、手術(shù)時(shí)間、手術(shù)出血量、融合節(jié)段數(shù)、隨訪時(shí)間、術(shù)前影像學(xué)參數(shù)及SRS-22評(píng)分均無統(tǒng)計(jì)學(xué)差異(P0.05)。術(shù)后隨訪24~69個(gè)月,共有13例患者發(fā)生DJK,發(fā)生率為8.4%,LIVSSV組患者DJK發(fā)生率(25.8%)高于LIV≥SSV組(4.1%)(χ~2=12.320,P0.001)。發(fā)生DJK患者與未發(fā)生DJK患者術(shù)前影像學(xué)參數(shù)及SRS-22評(píng)分均無顯著性差異(P0.05),但末次隨訪時(shí),發(fā)生DJK患者的胸椎后凸角、胸腰段后凸角、矢狀面軸向距離、遠(yuǎn)端交界角均高于未發(fā)生DJK患者,且SRS-22疼痛評(píng)分低于未發(fā)生DJK患者,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:遠(yuǎn)端固定椎-矢狀面穩(wěn)定椎位置關(guān)系顯著影響Lenke 1A型AIS患者術(shù)后DJK的發(fā)生率,遠(yuǎn)端融合至SSV或其遠(yuǎn)端椎體可以顯著降低術(shù)后DJK的發(fā)生率,更好地維持矢狀面平衡。
[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，

本文編號(hào)：2217396