在青少年特发性Lenke 1型和2型脊柱侧凸的后路矫正固定后，术前支点侧弯曲对远端附加灵活性评估的应用

IF 1.6 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2025-05-12 DOI:10.1007/s43390-025-01104-0

Tetsutaro Abe, Masashi Miyazaki, Noriaki Sako, Nobuhiro Kaku

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引用次数: 0

摘要

目的：研究Lenke 1,2型青少年特发性脊柱侧凸（AIS）的远端附加（DAO）相关因素，特别是术前支点侧弯（FSB）的柔韧性评估。此外，本研究的第二个目的是比较在站立和仰卧位下获得的支点侧弯（FSB）和主动侧弯（ASB） x线片在评估主曲线灵活性方面的有效性。方法：对32例Lenke 1、2型AIS行后路矫正固定的患者进行分析。采用全椎弓根螺钉法进行矫正，固定尾端为最后接触椎体（LTV）。影像学参数，如站立Cobb角(胸近端，PT；主胸，MT；分别于术前、术后及术后2年测量胸腰椎（TL）。并对ASB和FSB应力条件下的Cobb角进行了评价，计算出与站立Cobb角的差值为ΔASB和ΔFSB。根据DAO的发生情况进行分组。结果：12例患者发生DAO (37.5%)；DAO组与非DAO组比较，ΔFSB(PT)（11.2±6.0 vs. 6.9±5.8,p = 0.04）、ΔFSB(MT)（43.9±13.1 vs. 35.9±6.7,p = 0.02）和矫正率（MT）（81.2±8.4 vs. 73.6±9.8,p = 0.02）均显著高于DAO组。Logistic回归分析显示，发生DAO的危险因素为ΔFSB (MT)（优势比1.23±0.098,p = 0.03）和矫正率（MT）（优势比1.17±0.083,p = 0.04）。结论：ΔFSB和MT矫正率是DAO的危险因素。在MT矫正较大的情况下，冠状面在TL中失衡，这可能在术后过程中导致DAO。对于术前FSB有显著MT矫正的患者，应注意最低固定椎体（LIV）的设置，以防止DAO。

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Utility of flexibility assessment by preoperative fulcrum-side bending for distal adding-on after posterior corrective fixation in adolescent idiopathic scoliosis Lenke types 1 and 2.

Purpose: To examine the factors associated with distal adding-on (DAO) in Lenke type 1, 2 adolescent idiopathic scoliosis (AIS), particularly concerning flexibility assessment using preoperative fulcrum side bending (FSB). In addition, a secondary aim of this study was to compare the effectiveness of Fulcrum Side Bending (FSB) and Active Side Bending (ASB) radiographs, obtained in standing and supine positions, in assessing the flexibility of the main curve.

Methods: We analysed 32 patients who underwent posterior corrective fixation for Lenke type 1, 2 AIS. Correction was performed using the all-pedicle screw method and the fixed caudal end was the last touching vertebra (LTV). Radiographic parameters, such as the standing Cobb angle (proximal thoracic, PT; main thoracic, MT; thoracolumbar, TL), were measured before surgery, after surgery and 2 years postoperatively. The Cobb angle was also evaluated under stress conditions of ASB and FSB, and the difference from the standing Cobb angle was calculated as ΔASB and ΔFSB. Patients were grouped based on the occurrence of DAO.

Results: DAO occurred in 12 patients (37.5%); comparing the DAO and non-DAO groups, ΔFSB(PT) (11.2 ± 6.0 vs. 6.9 ± 5.8, p = 0.04) and ΔFSB(MT) (43.9 ± 13.1 vs. 35.9 ± 6.7, p = 0.02) and correction rate (MT) (81.2 ± 8.4 vs. 73.6 ± 9.8, p = 0.02) were significantly greater. Logistic regression analysis showed that the risk factors for DAO were ΔFSB (MT) (odds ratio 1.23 ± 0.098, p = 0.03) and correction rate (MT) (odds ratio 1.17 ± 0.083, p = 0.04).

Conclusions: ΔFSB and correction rate in MT were a risk factor for DAO. In cases with large MT corrections, the coronal plane was overbalanced in the TL, which could cause DAO during the postoperative course. Care should be taken in the setting of the lowest instrumented vertebra (LIV) to prevent DAO in patients with significant MT correction on preoperative FSB.

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来源期刊

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.