摘要
目的探讨肋骨畸形(RD)对先天性脊柱侧凸(CS)矫形术后脊柱整体平衡的影响。方法回顾性分析2009-01—2017-12郑州大学第一附属医院行CS矫形术治疗的86例患儿的临床资料。按是否存在肋骨畸形分为RD组(52例)和NRD组(34例)。比较2组患儿的临床资料、术前和术后2周、术后2 a时依据全脊椎正侧位X线检查结果,测量、记录、分析影像学参数资料。结果(1)除RD组的术中输血量大于NRD组,差异有统计学意义(P<0.05)外,2组患儿的基线资料和术前影像学参数差异均无统计学意义(P>0.05)。(2)术后2周时RD组主弯(MC)的Cobb角大于NRD组,Cobb角减小率(CAD)低于NRD组,差异有统计学意义(P<0.05);2组患者的其他影像学参数差异均无统计学意义(P>0.05)。(3)术后2 a时RD组患儿的脊柱矢状位轴(SVA)、CAD小于NRD组,近端交界角(PJA)的变化量(ΔPJA)大于NRD组,差异均有统计学意义(P<0.05);2组患儿的其他影像学参数差异均无统计学意义(P>0.05)。(4)术后随访2 a期间,RD组患儿近端交界性后凸(PJK)的发生率高于NRD组,差异有统计学意义(P<0.05)。结论RD对CS术后脊柱整体平衡有负面影响,合并RD患儿的冠状面CAD明显降低,并且矢状面上存在更高的PJK发生率。
Objective To investigate the effects of concomitant rib deformity(RD)on the postoperative spinal curve correction and the overall balance of spine in congenital scoliosis(CS)patients.Methods Patients with congenital scoliosis who underwent posterior segmental pedicle screw instrumentation correction surgery in the First Affiliated Hospital of Zhengzhou University from 2009-1 to 2017-12 were evaluated retrospectively.According to whether rib deformity existed or not,patients were divided into the rib deformity(RD)group and the non-rib deformity(NRD)group.The full-spine X-rays examinations were taken for each patient during the preoperative,2-week postoperative and 2-year follow-up after surgery,and then were measured.Radiographic parameters obtained and other perioperative data were recorded and compared to confirm the impacts of rib deformity through statistical methods.Results A total of 86 patients with congenital scoliosis were recorded,including 52 patients in the RD group and 34 patients in the NRD group.Except for the higher intraoperative blood transfusion in the RD group(P<0.05),there was no statistical difference in baseline data between the two groups(P>0.05).The RD group showed a larger Cobb angle(P=0.031)and a smaller Cobb angle decrease(CAD)(P<0.001)postoperatively.For the last follow-up,the RD patients had a smaller sagittal vertical axis(SVA)(P<0.05)and Cobb angle decrease(CAD)(P<0.05).In addition,the RD group had a significantly larger increasing Proximal Junctional Angle(ΔPJA)(P<0.05).The incidence of PJK was higher in RD group than in NRD group(34.62%vs.14.71%),and Pearson Chi-square test results showed that a significant existed differences between the two groups(P<0.05).Conclusion For congenital scoliosis patients,rib deformities have a negative effect on the global balance of spine after correction,especially leading to a significantly lower correction rate of the Cobb angle on coronal plane,and a higher incidence of proximal junctional kyphosis(PJK)on sagittal plane.
作者
蔡满地
范永刚
苏显俊
张华峰
王文刚
倪双飞
夏磊
Cai Mandi;Fan Yonggang;Su Xianjun;Zhang Huafang;Wang Wengang;Ni Shuangfei;Xia Lei(Department of orthopedics,the First Affiliated Hospital of Zhengzhou University,Zhengzhou,450052,China)
出处
《河南外科学杂志》
2021年第4期1-4,共4页
Henan Journal of Surgery
基金
河南省科技攻关项目(172102310090)。
关键词
先天性脊柱侧凸
肋骨畸形
矫形效果
脊柱整体平衡
矢状面失衡
近端交界性后凸
Congenital scoliosis
Rib deformity
Correction effect
global balance of spine
sagittal imbalance
Proximal Junctional Kyphosis
作者简介
通讯作者:夏磊,E-mail:zdyfyxialei@163.com。
