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首页> 外文期刊>Spine >The crankshaft phenomenon after posterior Harrington fusion in skeletally immature patients with thoracic or thoracolumbar idiopathic scoliosis followed to maturity.
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The crankshaft phenomenon after posterior Harrington fusion in skeletally immature patients with thoracic or thoracolumbar idiopathic scoliosis followed to maturity.

机译：骨骼发育不全的胸部或胸腰段特发性脊柱侧弯的哈灵顿后路融合术后的曲轴现象逐渐成熟。

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STUDY DESIGN: This retrospective study evaluated the progression of deformity after posterior fusion by reviewing 63 consecutive patients with idiopathic scoliosis who were all in Risser sign 0 at the time of surgery. All patients were observed beyond the time of skeletal maturity. Average follow-up time was 9 years and 8 months (range, 5-16 years). OBJECTIVES: To investigate the risk factors for the crankshaft phenomenon after posterior fusion and to build a model for predicting the probability of curve progression until maturation of growth. SUMMARY OF BACKGROUND DATA: There remains considerable controversy concerning the incidence, risk factors, and necessity of combined anterior fusion to prevent the crankshaft phenomenon in patients who are skeletally immature. METHODS: Serial radiographs were measured for Cobb angle, apical rotation according to Perdriolle, and apical rib-vertebra angle of Mehta. Multivariate and univariate logistic regression analysis was performed using seven potential predictors as independent variables and Cobb angle progression and rotational progression as dependent variables. RESULTS: Average progression of deformity was 3 degrees Cobb angle (range, -8-16 degrees) and 3 degrees Perdriolle rotation (range, -9-17 degrees). Progression of deformity more than 5 degrees of either Cobb angle or rotation was observed in 22 (35%) of 63 curves with 7 (11%) of 63 curves greater than 10 degrees. Chronologic age and skeletal age were found to be significantly associated with progression of deformity in univariate analysis. In multivariate analysis, only skeletal age seemed to be independently prognostic. The authors tried to build the logistic model using the three factors of chronologic age, skeletal age, and apical rib-vertebra angle. This model correctly classified 81% of all patients as progressive or nonprogressive. The positive predictive value was 90%. CONCLUSIONS: The results showed that patients with chronologic age of 11 years of younger, especially those with a skeletalage of 10 years or younger, had a high estimated probability of progression of deformity. The progression was fairly moderate, however, with an average Cobb angle of 9 degrees and average rotation of 7 degrees, which neither the patients nor the surgeon believed was of such magnitude as to warrant routine combined anterior fusion.
机译：研究设计：这项回顾性研究通过回顾63例在手术时均处于Risser标志0的连续性特发性脊柱侧弯患者，评估了后路融合术后畸形的进展。观察所有患者的骨骼成熟时间。平均随访时间为9年8个月（范围5-16年）。目的：调查后路融合后曲轴现象的危险因素，并建立一个模型来预测直至增长成熟的曲线发展的可能性。背景数据概述：关于骨骼发育不全的患者，其发生率，危险因素以及联合前路融合以预防曲轴现象的必要性仍存在争议。方法：连续X光片测量Cobb角，根据Perdriolle的根尖旋转以及Mehta的根尖肋-椎骨角。使用七个潜在的预测变量作为自变量，以Cobb角进展和旋转进展作为因变量，进行了多变量和单变量逻辑回归分析。结果：平均畸形进展为3度Cobb角（范围-8-16度）和3度Perdriolle旋转（范围-9-17度）。在63条曲线中的22条（35％）中，观察到畸形进展超过Cobb角或旋转的5度以上，而在63条曲线中有7条（11％）大于10度。在单变量分析中，发现年龄和骨骼年龄与畸形进展显着相关。在多变量分析中，只有骨骼年龄似乎是独立的预后。作者试图使用年代年龄，骨骼年龄和根尖脊椎-椎骨角这三个因素来构建逻辑模型。该模型将所有患者中的81％正确分类为进行性或非进行性。阳性预测值为90％。结论：结果显示，按年龄顺序年龄小于11岁的患者，尤其是骨骼年龄小于或等于10岁的患者，估计有较高的畸形进展可能性。然而，进展相当温和，平均Cobb角为9度，平均旋转度为7度，患者和医生都不认为需要进行常规的前路融合治疗。

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