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首页> 外文期刊>Spine >Selective thoracic fusion in adolescent idiopathic scoliosis: factors influencing the selection of the optimal lowest instrumented vertebra.
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Selective thoracic fusion in adolescent idiopathic scoliosis: factors influencing the selection of the optimal lowest instrumented vertebra.

机译：青少年特发性脊柱侧凸的选择性胸廓融合术：影响最佳最低仪器椎骨选择的因素。

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STUDY DESIGN: Analysis of multicenter, prospectively collected data. OBJECTIVE: To determine how selection of the lowest instrumented vertebra (LIV) relative to the stable vertebra (SV) and the end vertebra (EV) effects correction of the main thoracic curve, compensatory lumbar curve, and incidence of coronal decompensation after selective thoracic fusion. SUMMARY OF BACKGROUND DATA: Traditionally, in Lenke type 1B and 1C curves, the LIV is selected as the SV; however, selecting the LIV continues to be controversial. METHODS: Inclusion criteria were patients with adolescent idiopathic scoliosis (AIS) with Lenke type 1B, 1C, or 3C curves that had a selective thoracic fusion with the LIV from T11 to L1 (n=172). The patients were divided into three curve patterns on the basis of the relative position of SV and EV. Group SBE (stable below end) (n=93) had SV below EV, group SAE (stable at end) (n=66) had SV at the EV, and group EBS (end below stable) (n=13) has EV below SV. In addition, each group was divided into six subgroups based on the selected LIV: LIV above SV, at the SV, below SV, above EV, at the EV, and below EV. Each was compared for preoperative and 2-year postoperative radiographic parameters and clinical data. RESULTS: In group SBE, the 2-year postoperative thoracic curve correction rate when the LIV was below the EV (64%+16%) was significantly greater than when the LIV was at the EV (54%+13%; P<0.001). The 2-year postoperative spontaneous lumbar curve correction (SLCC) rate similarly correlated with the LIV selection subgroups, 52%+20% and 43%+19%, respectively (P=0.03). In group SAE, the 2-year postoperative thoracic curve correction rate when the LIV was below the EV/SV (64%+14%) was significantly greater than when the LIV was at the EV/SV (52%+14%; P=0.004). The 2-year postoperative SLCC rate for group SAE similarly correlated with the LIV selection subgroup, 56%+16% and 38%+21%, respectively (P<0.01). In group EBS, the 2-year postoperative thoracic curve correction and SLCC rates were not significantly different among the LIV selection subgroups; however, the incidence of decompensation was 38%. CONCLUSION: When performing a selective thoracic fusion of Lenke type 1B, 1C, and 3C AIS curves in which the SV was at/or below the EV, the greatest correction of the main thoracic and compensatory lumbar curves occurred when the LIV was at/or at least one level distal to the SV. This more distal LIV did not result in an increased rate of truncal imbalance.
机译：研究设计：对多中心，前瞻性收集的数据进行分析。目的：确定相对于稳定椎骨（SV）和末梢椎骨（EV）的最低仪器化椎骨（LIV）的选择如何影响选择性胸廓融合后主胸曲线，代偿性腰椎曲线和冠状失代偿的发生。背景数据摘要：传统上，在Lenke类型1B和1C曲线中，LIV被选择为SV;但是，选择LIV仍然存在争议。方法：纳入标准为Lenke 1B，1C或3C型曲线的青少年特发性脊柱侧凸（AIS）患者，其T11至L1时与LIV选择性胸廓融合（n = 172）。根据SV和EV的相对位置，将患者分为三个曲线模式。 SBE组（在末尾稳定）（n = 93）的SV低于EV，SAE组（在末尾稳定）（n = 66）的EV包含SV，而EBS组（末尾稳定）（n = 13）的EV低于SV。此外，根据选定的LIV将每个组分为六个子组：LIV高于SV，SV低于SV，EV高于EV，EV低于EV。分别比较术前和术后2年的影像学参数和临床数据。结果：在SBE组中，当LIV低于EV时（64％+ 16％）的2年术后胸曲线校正率显着高于当LIV低于EV时（54％+ 13％; P <0.001）。 ）。术后2年自发性腰椎弯曲矫正率（SLCC）与LIV选择亚组相似，分别为52％+ 20％和43％+ 19％（P = 0.03）。在SAE组中，当LIV低于EV / SV时，术后2年的胸廓曲线矫正率（64％+ 14％）显着大于当LIV处于EV / SV时（52％+ 14％; P = 0.004）。 SAE组术后2年SLCC率与LIV选择亚组相似，分别为56％+ 16％和38％+ 21％（P <0.01）。在EBS组中，LIV选择亚组的2年术后胸曲线校正和SLCC率无显着差异。但是，代偿失调的发生率为38％。结论：当进行SV在/或低于EV的Lenke 1B，1C和3C型AIS曲线的选择性胸廓融合时，当LIV在/或以下时，对主胸和代偿性腰椎曲线的校正最大SV远端至少一层。远端LIV的增加不会导致截断不平衡率的增加。

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