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目的探寻导致行非选择性胸弯矫正治疗的Lenke 2型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者术后即刻发生肩关节失平衡的影像学因素。方法研究对象包括32例Lenke 2型AIS患者,女25例,男7例。所有患者上端固定至T1或T2水平。术前全脊柱片影像学测量指标包括:(1)锁骨角;(2)T1倾斜角;(3)上胸弯Cobb’s角;(4)主胸弯Cobb’s角;(5)上胸弯Bending位片Cobb’s角;(6)主胸弯Bending位片Cobb’s角;(7)上胸弯柔韧度;(8)主胸弯柔韧度;(9)上胸弯顶椎偏移距离(apical vertebrae translation,AVT);(10)主胸弯AVT;(11)术前肩关节影像学高度(radiographic shoulder height,RSH)。分析以上术前影像学指标,上胸弯矫正率以及主胸弯矫正率与术后RSH的相关关系。术后RSH>10 mm定义为肩关节失平衡。结果 6例(18.8%)术后发生肩关节失平衡。术前影像学指标与术后RSH相关性无统计学意义(P>0.05),仅有主胸弯术后矫正率与术后RSH相关性有统计学意义(P<0.05)。结论术前的影像学指标均无法预测行非选择性胸弯矫正的Lenke 2型AIS患者术后肩关节平衡情况。主胸弯过度矫正是导致术后肩关节失平衡的主要原因。
Objective To explore the imaging factors of shoulder imbalance in patients with Lenke type 2 adolescent idiopathic scoliosis (AIS) leading to non-selective thoracic correction. Methods Subjects included 32 patients with Lenke type 2 AIS, 25 were female and 7 were males. All patients were fixed to the T1 or T2 level. The preoperative measurement of the whole spinal column radiographs included: (1) the angle of the clavicle; (2) the tilt angle of T1; (3) the Cobb’s angle of the upper thoracic curve; (4) the Cobb’s angle of the main thoracic curve; Cobb’s angle; (6) Bending Cobb’s angle of the main chest; (7) Flexibility of the upper chest; (8) Flexibility of the main chest; (9) Apical vertebrae translation, AVT); (10) AVT of the main chest; (11) preoperative radiographic shoulder height (RSH). Analysis of the above preoperative imaging indicators, the upper chest flexion rate and the main thoracic correction rate and the correlation between postoperative RSH. Postoperative RSH> 10 mm was defined as shoulder imbalance. Results Six cases (18.8%) suffered shoulder imbalance after operation. There was no significant difference between the preoperative imaging indexes and the postoperative RSH (P> 0.05). Only the correlation between the correction rate after primary thoracic surgery and postoperative RSH was statistically significant (P <0.05). Conclusions Preoperative imaging can not predict the balance of shoulder joint in patients with Lenke type 2 AIS treated with nonselective thoracic correction. Main chest overcorrection is the leading cause of postoperative unbalanced shoulder joint main reason.