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目的:探讨Lenke 2型青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)患者接受胸椎后路选择性矫形融合术术后双肩失平衡的风险因素。方法:系统性回顾分析168例接受胸椎后路选择性矫形融合术的Lenke 2型AIS患者术前、术后即刻与末次随访时站立位全脊柱X线片锁骨角(clavicle angle,CA)、影像学双肩高度差(radiographic shoulder height,RSH)、胸1椎体(T1)倾斜角、上胸弯(proximal thoracic,PT)Cobb角、主胸弯(main thoracic,MT)Cobb角、代偿性腰弯(compensatory lumbar curve,CL)Cobb角、主胸弯顶椎旋转度(the apical translation of the main thoracic curve,AVT)、术前各弯的柔韧性、术后各弯矫正率等影像学参数;利用独立样本t检验、卡方检验、logistic回归分析导致Lenke 2型AIS患者术后双肩失平衡的风险因素。结果:168例患者中,28例(16.7%)患者末次随访时出现术后双肩失平衡;独立样本t检验显示,术后双肩失平衡组其术前MT Cobb角明显大于术后双肩平衡组术前MT Cobb角;术后双肩失平衡组术后即刻RSH,末次随访时T1倾斜角、CA、RSH均明显大于术后双肩平衡组;此外,独立样本t检验还显示,2组患者间下端固定椎(lower instrumented vertebra,LIV)、远侧端椎(end vertebra,EV)、中位椎(neutral vertebra,NV)、颈7铅垂线所触及的最远端椎体(last vertebra that CSVL touches,LTV)水平存在统计学差异;logistic回归分析显示,术前站立位MT Cobb角度数(OR=1.112,95%CI=1.017~1.088,P=0.010)、LIV-LTV值(OR=2.635,95%CI=1.363~9.442,P=0.012)与术后双肩失平衡的发生具有显著相关性。结论:本研究提示Lenke 2型AIS患者前大MT Cobb角与大LIV-LTV差值对Lenke 2型AIS患者术后双肩失平衡的发生具有促进作用。
Objective: To investigate the risk factors of shoulder imbalance in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) undergoing selective posterior thoracic surgery. Methods: A retrospective analysis of 168 patients with Lenke type 2 AIS who underwent selective thoracic posterior selective elective surgery was performed before, immediately after and immediately after surgery. At the final follow-up, the total spine angle (CA) Radiographic shoulder height (RSH), inclination of T1 vertebral body (T1), Cobb angle of proximal thoracic (PT), Cobb angle of main thoracic (MT), compensatory waist (CL) Cobb angle, the apical translation of the main thoracic curve (AVT), flexibility of each bend before operation, correction rate of each bend after operation; Using independent samples t-test, chi-square test, logistic regression analysis led to Lenke type 2 AIS postoperative shoulder imbalance risk factors. Results: Among the 168 patients, 28 cases (16.7%) had postoperative shoulder unbalance at the final follow-up. The independent sample t-test showed that preoperative MT Cobb angle was significantly greater than postoperative shoulder-shoulder balance group Pre-MTb Cobb angle; post-operation unbalanced group RSH postoperative immediately after the end of follow-up T1 tilt angle, CA, RSH were significantly greater than postoperative shoulder balance group; In addition, independent sample t test also showed that the two groups were fixed between the lower end Vertebrae (LIV), distal vertebra (EV), neutral vertebra (NV), the most distal vertebrae touched by the neck 7 plumb line (last vertebra that CSVL touches, (OR = 1.112, 95% CI = 1.017-1.088, P = 0.010), LIV-LTV (OR = 2.635, 95% CI = 1.363 ~ 9.442, P = 0.012) had a significant correlation with the occurrence of postoperative unbalanced shoulder. CONCLUSIONS: This study suggests that pre-large MT Cobb angle and large LIV-LTV difference in Lenke type 2 AIS patients may contribute to postoperative shoulder imbalance in patients with Lenke type 2 AIS.