摘要
目的分析含有上胸弯的特发性脊柱侧凸患者的矫形效果。方法含有上胸弯的特发性脊柱侧凸患者26例,其中双胸弯(PUMC Ⅱa)13例,三弯13例(PUMC Ⅲa 11例,Ⅲb 2例),分为手术融合范围含上胸弯组(A 组,18例),未含上胸弯组(B 组,8例)。根据其临床及影像学资料,对侧凸及双肩平衡的矫形效果进行回顾性分析。结果上胸弯与主胸弯冠状面 Cobb 角术前 A 组为45.3°和61.2°,B 组为35.6°和58.9°,术后 A 组为24.2°和20.1°、B 组为26.4°和20.3°,A 组上胸弯与主胸弯冠状面矫形率为48.2%和68.7%,B 组上胸弯自动矫形率与主胸弯冠状面矫形率为24.5%和66.3%,上胸弯矫形率 A 组明显优于 B 组,主胸弯矫形率二组间比较差异无统计学意义(P>0.05)。术后放射学检查双肩高度差>10 mm(双肩不平衡)的发生比例,A 组与 B 组差异有统计学意义(P<0.05)。术前左肩高或双肩等高的患者术后双肩失平衡的发生率明显高于术前右肩高的患者(P<0.05)。结论对于含有上胸弯、术前左肩高或双肩等高的特发性脊柱侧凸患者,手术矫形时应考虑融合上胸弯,以获得更好的上胸弯冠状面矫形率,同时避免或减少术后双肩失平衡的发生。
Objective To analyze the correction results of the adolescent idiopathic scoliosis patients with a proximal thoracic （PT） curve. Methods There were 13 cases of double thoracic curve （PUMC Ⅱa） and 13 cases of triple curve （PUMC Ⅲa 11 cases, Ⅲb 2 case）. The upper instrumented vertebra were at T3 or above （fusion level including PT curve, Group A） in 18 cases, and at T4 or T5 （PT curve not fused, Group B） in 8 cases. Reviewing the medical records and radiographs of 26 adolescent idiopathic scoliosis patients with a proximal thoracic curve that underwent corrective surgery, the changes of the curve and the shoulder balance were analyzed. Results The coronal Cobb angles of the PT curve and the main thoracic （MT） curve before operation were 45.3° and 61.2° in group A, 35. 6° and 58.9° in group B. After operation, they were corrected to 24. 2° and 20. 1°, 26.4° and 20. 3°, respectively. The correction rates of the PT curve and MT curve were 48. 2% and 68.7%, 24. 5% and 66. 3%, respectively. The correction rates of the PT curve of group A was significantly better than group B （ P = 0. 006）, but for the MT curve, the difference was not significant （ P = 0. 694）. The incidence of radiographic shoulder height （RSH） over than 10 mm（ shoulder imbalance） after operation in group B was higher than group A significantly （ P = 0. 038）. The incidence rate of shoulder imbalance after operation of the patients with a left higher shoulder or balance shoulder was significantly higher than that of the patients with a right higher shoulder （ P = 0. 015）. Conclusions Fusing the PT in patients with a left shoulder not lower than right side will make better coronal correction results of the PT curve and reduce the incidence of postoperative shoulder imbalance.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第8期520-524,共5页
Chinese Journal of Surgery
关键词
脊柱侧凸
青少年
上胸弯
放射学双肩高度差
Scoliosis
Adolesence
Proximal thoracic curve
Radiographic shoulder height
