Can We Stop Distally at LSTV-1 for Adolescent Idiopathic Scoliosis With Lenke 1A/2A Curves?
Can We Stop Distally at LSTV-1 for Adolescent Idiopathic Scoliosis With Lenke 1A/2A Curves?
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DOI：
10.1097/brs.0000000000004206
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发表时间：
2022-04-15
期刊：
影响因子：
3
通讯作者：
Zhu, Zezhang
中科院分区：
文献类型：
--
作者：
Qin, Xiaodong;Qiu, Yong;Zhu, Zezhang
研究设计。一项回顾研究。目标。为了确定在哪种情况下，最后一个基本接触椎体(LSTV-1)近端的一个节段可能是有效的最低固定椎体(LIV)，在这种情况下，远端融合应该延伸到最后一个基本接触椎体(LSTV)，并确定远端增加的危险因素。背景数据摘要。后路胸椎融合术保留更多的腰椎活动节段已成为治疗青少年特发性脊柱侧凸(AIS)的主流手术方式。虽然以前的研究建议选择LSTV作为LIV，但在某些情况下，选择LSTV-1作为LIV仍然可以获得良好的结果。方法：研究方法。94例患者在后路胸椎内固定术后获得至少2年的随访，其中LSTV-1被选为LIV。根据先前定义的参数，通过首次勃起X线片和2年随访之间的远端附加物来确定患者。分析了影响附加药物发生率的因素。结果。平均随访时间37.7+/-15.8个月。40例(42.6%)LSTV-1患者在最后一次随访中获得良好的疗效。几个与远端Add-On显著相关的术前危险因素包括较低的Riser(P=0.001)、较长的胸弯长度(P=0.005)、较大的LSTV-1旋转和偏斜度(P<；0.001)以及术前冠状不平衡(P=0.013)。结论。选择LSTV-1作为LV时，骨骼不成熟、胸弯较长、术前冠状不平衡、旋转度大和LSTV-1偏斜的患者增加了远端增加的风险。在这种情况下，远端融合水平应延伸至LSTV；而在其他情况下，LSTV-1可能是有效的LIV。
Study Design. A retrospective study. Objective. To determine in which case one level proximal to last substantially touching vertebra (LSTV-1) could be a valid lowest instrumented vertebra (LIV), in which case distal fusion should extend to last substantially touching vertebra (LSTV), and to identify risk factors for distal adding-on. Summary of Background Data. Posterior thoracic fusion to save more lumbar mobile segments has become the mainstay of operative treatment for adolescent idiopathic scoliosis (AIS) with Lenke 1A/2A curves. Although previous studies have recommended selecting the LSTV as LIV, good outcomes could still be achieved in some cases when LSTV-1 was selected as LIV. Methods. Ninety-four patients were included in the study with a minimum of 2-year follow-up after posterior thoracic instrumentation, in which LSTV-1 was selected as LIV. Patients were identified with distal adding-on between first erect radiographs and 2-year follow-up based on previously defined parameters. Factors associated with the incidence of adding-on were analyzed. Results. The mean follow-up duration was 37.7 +/- 15.8 months. Forty patients (42.6%) with LSTV-1 selected as LIV achieved good outcomes at the last follow-up. Several preoperative risk factors significantly associated with distal adding-on were identified, including lower Risser (P = 0.001), longer thoracic curve length (P = 0.005), larger rotation and deviation of LSTV-1 (P < 0.001), and preoperative coronal imbalance (P = 0.013). Conclusion. Skeletally immature patients with long thoracic curve, preoperative coronal imbalance, large rotation, and deviation of LSTV-1 are at increased risk of distal adding-on when selecting LSTV-1 as LIV. Under this condition, distal fusion level should extend to LSTV; while in other case, LSTV-1 could be a valid LIV.