选择稳定椎体(SV)或SV-1为最低固定椎体时Lenke 1A曲线三维矫正及临床效果的比较

IF 1.9 2区 医学 Q2 ORTHOPEDICS
Clinics in Orthopedic Surgery Pub Date : 2025-04-01 Epub Date: 2025-02-25 DOI:10.4055/cios23228
Ismail Emre Ketenci, Hakan Serhat Yanik
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引用次数: 0

摘要

背景:在Lenke 1A曲线中,最低测量椎体(LIV)的选择是有争议的。在冠状面、矢状面和横切面对齐LIV对于整型脊柱侧凸的矫正以及未固定腰椎曲线的对齐都很重要。在这项研究中,我们的目的是评估Lenke 1A曲线的三维校正和临床结果,根据LIV水平,用杆旋转(RD)手法校正。方法:前瞻性收集46例经后路内固定融合治疗的Lenke 1A型特发性脊柱侧凸患者的资料进行回顾性评价。根据患者的LIV水平分为2组:稳定椎体(SV)组(25例)和靠近SV 1位(SV-1)组(21例)。根据影像学和临床结果对患者术前和术后进行比较。冠状面测量参数为胸曲线Cobb角、肩平衡、冠状面平衡、LIV平移、LIV倾斜;矢状面,胸椎后凸,腰椎前凸,矢状面平衡,远端关节角。横切面分析包括计算机断层扫描下根尖椎体(AV)、LIV和LIV+1的旋转测量。采用脊柱侧凸研究协会(SRS)-22问卷对临床结果进行评估。记录手术时间。结果:两组患者术前影像学指标差异无统计学意义。两组患者术后胸曲线Cobb角、肩部平衡、LIV平移、LIV倾斜均有明显改善。术后两组的房室旋转均明显减少。术后LIV和LIV+1的旋转未见明显变化。两组之间的临床结果和手术时间相似。结论:Lenke 1A患者选择LIV为SV或SV-1,在冠状面和矢状面重建以及AV和LIV旋转方面的结果相似。通过RD机动,可以在LIV和LIV+1处实现可接受的旋转量。两个LIV水平的放射学和功能结果都令人满意。为了节省1个更多的移动段,如果可能的话,选择SV-1作为LIV是合理的,以便在所有3个平面中获得对齐良好的LIV。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of 3-Dimensional Correction and Clinical Outcomes of Lenke 1A Curves with the Stable Vertebra (SV) or SV-1 Selected as the Lowest Instrumented Vertebra.

Backgroud: Lowest instrumented vertebra (LIV) selection is controversial in Lenke 1A curves. Alignment of the LIV in coronal, sagittal, and transverse planes is important for correction of overall scoliosis, as well as the alignment of uninstrumented lumbar curve. In this study, we aimed to evaluate the 3-dimensional correction and clinical outcomes of Lenke 1A curves, corrected with rod derotation (RD) maneuver, according to the LIV level.

Methods: Prospectively collected data of 46 consecutive idiopathic scoliosis surgery patients with Lenke 1A scoliosis who had been treated with posterior instrumentation and fusion were retrospectively evaluated. Patients were divided into 2 groups according to the LIV level: stable vertebra (SV) group (25 patients) and 1 level proximal to SV (SV-1) group (21 patients). Patients were compared pre- and postoperatively according to radiographic and clinical outcomes. Measured parameters in coronal plane were Cobb angle of thoracic curve, shoulder balance, coronal balance, LIV translation, and LIV tilt; in sagittal plane, thoracic kyphosis, lumbar lordosis, sagittal balance, and distal junctional angle. Transverse plane analysis included rotational measurement of apical vertebra (AV), LIV, and LIV+1 with computerized tomography. Clinical outcomes were evaluated with Scoliosis Research Society (SRS)-22 questionnaire. Surgical times were noted.

Results: There were no statistically significant differences between the 2 groups in terms of preoperative radiographic values. In both groups, Cobb angle of thoracic curve, shoulder balance, LIV translation, and LIV tilt improved significantly after the surgery. Postoperatively, AV rotation decreased in both groups significantly. No significant change was observed in rotations of LIV and LIV+1 after the surgery. Clinical outcomes and surgical times were similar between the groups.

Conclusions: Selection of the LIV as SV or SV-1 in Lenke 1A patients led to similar results in terms of coronal and sagittal plane reconstruction, as well as AV and LIV rotation. With RD maneuver, an acceptable amount of rotation could be achieved at LIV and LIV+1. Radiologic and functional outcomes were satisfactory in both LIV levels. To save 1 more mobile segment, it seems reasonable to select SV-1 as the LIV if possible in order to obtain a well-aligned LIV in all 3 planes.

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来源期刊
CiteScore
3.50
自引率
4.00%
发文量
85
审稿时长
36 weeks
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