Selective thoracic fusion for adolescent thoracic scoliosis secondary to Chiari I malformation: a comparison between the left and the right curves
Selective thoracic fusion for adolescent thoracic scoliosis secondary to Chiari I malformation: a comparison between the left and the right curves
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DOI：
10.1007/s00586-018-5855-y
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发表时间：
2019-03-01
影响因子：
2.8
通讯作者：
Zhu, Zezhang
中科院分区：
文献类型：
--
作者：
Jiang, Long;Qiu, Yong;Zhu, Zezhang
PurposeThe的目的是本研究的目的是比较选择性胸椎融合术在手术治疗的基亚里畸形I型（CMI）青少年与不同的曲线patterns.Methods63 CMI患者与左胸曲线（LTC）和63年龄和曲线大小匹配的CMI患者与右胸曲线（RTC）的临床结果。两组均行选择性胸椎融合术。在术前、术后即刻和末次随访时测量冠状面和矢状面参数，包括胸腰椎Cobb角、顶椎平移、躯干移位、胸椎后凸（TK）、腰椎前凸和矢状面垂直轴。两组间椎弓根螺钉置入的准确性也compared.ResultsAll术前影像学参数在两组匹配，除了TK（LTC组40.1度与RTC组23.0度，P=0.021）。LTC组术后即刻自发矫正率为56.9%，显著低于RTC组（67.9%）。LTC组躯干位移明显大于RTC组（15.1mm vs.8.0mm，P=0.038）。在最终随访时，两组的胸椎曲线矫正相当（59.9% vs. 62.6%，P=0.610）。椎弓根螺钉穿孔率两组之间是相似的。ConclusionsPatients with LTC和RTC都可以成功地纠正通过选择性胸椎融合与一个有前途的长期手术结果。伴有RTC的CMI患者在手术后往往有更好的腰椎曲线自发矫正。[图形]。
PurposeThe aim of this study was to compare the clinical outcomes of selective thoracic fusion in the surgical treatment of Chiari malformation type I (CMI) adolescents with different curve patterns.MethodsSixty-three CMI patients with left thoracic curve (LTC) and 63 age- and curve-magnitude-matched CMI patients with right thoracic curve (RTC) were recruited. Selective thoracic fusion was performed for two groups. The coronal and sagittal parameters including the thoracic and lumbar Cobb angle, apical vertebral translation, trunk shift, thoracic kyphosis (TK), lumbar lordosis and sagittal vertical axis were measured before surgery, immediately postoperative and at the final follow-up. The accuracy of pedicle screw placement between both groups was also compared.ResultsAll preoperative radiographic parameters were matched in both groups except for TK (LTC group 40.1 degrees vs. RTC group 23.0 degrees, P=0.021). The immediately postoperative spontaneous correction of the lumbar curve was 56.9% in LTC group, which was remarkably lower than in RTC patients (67.9%). Patients with LTC were found to have obviously increased trunk shift than those with RTC (15.1mm vs. 8.0mm, P=0.038). At the final follow-up, the correction of the thoracic curve was comparable between the two groups (59.9% vs. 62.6%, P=0.610). The rate of the pedicle screw perforations was similar between both groups.ConclusionsPatients with LTC and RTC can both be successfully corrected through selective thoracic fusion with a promising long-term surgical outcome. CMI patients with RTC tend to have a better spontaneous correction of the lumbar curve after surgery.[GRAPHICS].