【摘要】 [目的]评估单胸弯(LenkeⅠ型)特发性脊柱侧凸矫正患者术后及最少2年随访过程中肩部平衡的变化过程。[方法]回顾性分析2008年7月~2012年8月在本院脊柱侧弯中心接受手术治疗的特发性脊柱侧凸患者72例,男14例,女58例;平均年龄15.8岁(9~21岁),平均随访29.7个月(24~62个月)。均为LenkeⅠ型。研究利用术前术后及随访的全脊柱正侧位X线片测量双肩高度差、锁骨角等指标,并利用统计学软件SPSS 17对参数进行比较,分析手术及术后不同随访时间对患者肩部平衡的影响。[结果]72例患者皆采用单纯后路椎弓根钉棒矫正,手术完成顺利,无严重并发症发生。其中主胸弯Cobb角从术前平均(53.7±11.1)°矫正至术后平均(11.1±7.4)°,平均主弯矫正率为77.7%;上胸弯Cobb角从术前平均(23.2±7.6)°矫正至术后平均(7.4±11.1)°,平均主弯矫正率为70.6%。术前双肩高度差(RSH)及锁骨角(CA)分别为平均(1.3±1.0)cm和(3.0±1.9)°,术后矫正至平均(1.7±1.1)cm和(3.9±1.8)°,半年随访平均(1.4±1.0)cm和(3.0±1.8)°,1年随访平均(1.2±1.2)cm和(2.8±1.8)°,2年后随访平均(1.1±1.0)cm和(2.7±1.6)°,双肩高度差在术后及末次随访差异皆具统计学意义(P<0.05);在术后两年的随访中,RSH和CA指数分别得到了35%及31%的恢复,其术后1年内恢复所占比例分别为95%及97%。[结论]对于Lenke I型患者来说,手术矫正可能会导致肩部不平衡情况加重,但术后所残留的肩部不等高在术后远期功能重建中可以得到较好的恢复,而术后1年的时间段是肩部平衡恢复重建的关键时期。更多还原

【Abstract】 [Objective] To evaluate the recovery process of shoulder balance of single thoracic curve(Lenke I) idiopathic scoliosis patients at immediate postoperation and during at least two years follow-up period.[Methods] A retrospective analysis was made on 72 patients who underwent scoliosis surgery from July 2008 to August 2012,including male of 14 cases,female of 58 cases,with an average age of 15.8 years(range,9 to 21 years old).All patients received an average follow-up of 29.7months(range,24 ~ 62 months).All cases had been confirmed to be Lenke I idiopathic scoliosis.The pre-,post-operative full-spine radiographs were collected to measure shoulder height difference,clavicle angle,and statistical software SPSS 17 was used to analyze and compare the parameters and investigate the impacting factors influencing the change of shoulder balance from surgery to the last follow-up.[Results] All patients received successful posterior approach pedicle screw correction,without any serious complications.The main thoracic curve Cobb angle was corrected from preoperatively mean(53.7 ± 11.1) ° to postoperatively mean(11.1 ± 7.4) °,the average major curve correction rate was 77.7%.The upper thoracic curve Cobb angle was corrected from preoperatively average 23.2 ± 7.6° to postoperatively average 7.4 ± 11.1°,the average correction rate was70.6%.Preoperative shoulder height difference(RSH) and clavicle angle(CA) were average(1.3 ± 1.0) cm and(3.0 ±1.9) °,whereas changed to(1.7 ± 1.1) cm and(3.9 ± 1.8) ° immediately after correction,1.4 ± 1.0 cm and 3.0 ± 1.8° halfyear after surgery,(1.2 ± 1.2) cm and(2.8 ± 1.8) ° 1-year after surgery,and at 2 years after surgery,it decreased to(1.1 ±1.0) cm and(2.7 ± 1.6) °,indicating a statistically significant difference(P < 0.05) between pre-operative and the last follow-up results.RSH and CA indexes were corrected by 35% and 31%,the proportion of postoperative one year recovery of two indexes were 95% and 97%,respectively.[Conclusion] For Lenke I type patients,surgical correction may cause aggravated shoulder imbalances,but the residual shoulder imbalances could get better recovery in long-term postoperative reconstruction,and 1-year after surgery is the critical period for shoulder balance reconstruction.更多还原