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Abstract：
BACKGROUND: To analyze the factors affecting the loss of correction effect in patients with congenital scoliosis after one stage posterior hemivertebra resection, orthosis, fusion and internal fixation.
METHODS: Thirty-nine patients with congenital scoliosis (CS) who underwent one-stage posterior hemivertebra resection, orthosis, fusion and internal fixation were retrospectively included in Hebei Children\'s Hospital General demographic information of patients was collected. Preoperative and postoperative imaging indicators were compared, Including cobb Angle of the main curvature of the spine, segmental Cobb Angle, compensatory cephalic curve, compensatory curve on the caudal side, segmental kyphosis, coronal balance, sagittal balance, thoracic kyphosis, lumbar lordosis, and apical vertebra translation. Correlation analysis is used to evaluate the factors affecting the loss of judgment and correction effect, and the correlation indicators are included in the multi-factor Logistics regression.
RESULTS: In terms of radiographic indicators in the coronal plane, compared to preoperative values, significant improvements were observed in postoperative Cobb Angle of main curve (8.00°±4.62° vs. 33.30°±9.86°), Segmental Cobb angle (11.87°±6.55° vs. 31.29°±10.03°), Compensatory cephalic curve (6.22°±6.33° vs. 14.75°±12.50°), Compensatory curve on the caudal side (5.58°±3.43° vs. 12.61°±8.72°), coronal balance (10.95 mm ± 8.65 mm vs. 13.52 mm ± 11.03 mm), and apical vertebra translation (5.96 mm ± 5.07 mm vs. 16.55 mm ± 8.39 mm) (all P < 0.05). In the sagittal plane, significant improvements were observed in Segmental kyposis Angle (7.60°±9.36° vs. 21.89°±14.62°, P < 0.05) as compared to preoperative values. At the last follow-up, Segmental kyphosis Angle (6.09°±9.75° vs. 21.89°±14.62°, P < 0.05), Thoracic kyphosis (26.57°±7.68° vs. 24.06°±10.49°, P < 0.05) and Lumbar lordosis (32.12°±13.15° vs. 27.84°±16.68°, P < 0.05) had statistical significance compared with the preoperative department. The correlation analysis showed that the correction effect of the main curve Cobb angle was correlated with fixed segment length (rs=-0.318, P = 0.048), postoperative segment Cobb angle (rs=-0.600, P < 0.001), preoperative apical vertebra translation (rs = 0.440, P = 0.005), and spinal cord malformation (rs=-0.437, P = 0.005). The correction effect of segmental kyphosis was correlated with age (rs = 0.388, P = 0.037). The results of the multivariate logistic regression analysis revealed that postoperative segmental Cobb angle > 10° (OR = 0.011, 95%CI:0.001-0.234, P = 0.004), associated spinal cord anomalies (OR = 24.369, 95%CI:1.057-561.793, P = 0.046), and preoperative apical translation > 10 mm (OR = 0.012, 95%CI:0.000-0.438, P = 0.016) were influential factors in the progression of the main curve Cobb angle.
CONCLUSIONS: The one-stage posterior hemivertebra resection and short-segment corrective fusion with internal fixation are effective means to treat congenital scoliosis. However, attention should be paid to the loss of correction and curve progression during follow-up. Patients with spinal cord malformation and a large preoperative apical vertebra translation have a greater risk of losing the correction after surgery.
METHODS: Thirty-nine patients with congenital scoliosis (CS) who underwent one-stage posterior hemivertebra resection, orthosis, fusion and internal fixation were retrospectively included in Hebei Children\'s Hospital General demographic information of patients was collected. Preoperative and postoperative imaging indicators were compared, Including cobb Angle of the main curvature of the spine, segmental Cobb Angle, compensatory cephalic curve, compensatory curve on the caudal side, segmental kyphosis, coronal balance, sagittal balance, thoracic kyphosis, lumbar lordosis, and apical vertebra translation. Correlation analysis is used to evaluate the factors affecting the loss of judgment and correction effect, and the correlation indicators are included in the multi-factor Logistics regression.
RESULTS: In terms of radiographic indicators in the coronal plane, compared to preoperative values, significant improvements were observed in postoperative Cobb Angle of main curve (8.00°±4.62° vs. 33.30°±9.86°), Segmental Cobb angle (11.87°±6.55° vs. 31.29°±10.03°), Compensatory cephalic curve (6.22°±6.33° vs. 14.75°±12.50°), Compensatory curve on the caudal side (5.58°±3.43° vs. 12.61°±8.72°), coronal balance (10.95 mm ± 8.65 mm vs. 13.52 mm ± 11.03 mm), and apical vertebra translation (5.96 mm ± 5.07 mm vs. 16.55 mm ± 8.39 mm) (all P < 0.05). In the sagittal plane, significant improvements were observed in Segmental kyposis Angle (7.60°±9.36° vs. 21.89°±14.62°, P < 0.05) as compared to preoperative values. At the last follow-up, Segmental kyphosis Angle (6.09°±9.75° vs. 21.89°±14.62°, P < 0.05), Thoracic kyphosis (26.57°±7.68° vs. 24.06°±10.49°, P < 0.05) and Lumbar lordosis (32.12°±13.15° vs. 27.84°±16.68°, P < 0.05) had statistical significance compared with the preoperative department. The correlation analysis showed that the correction effect of the main curve Cobb angle was correlated with fixed segment length (rs=-0.318, P = 0.048), postoperative segment Cobb angle (rs=-0.600, P < 0.001), preoperative apical vertebra translation (rs = 0.440, P = 0.005), and spinal cord malformation (rs=-0.437, P = 0.005). The correction effect of segmental kyphosis was correlated with age (rs = 0.388, P = 0.037). The results of the multivariate logistic regression analysis revealed that postoperative segmental Cobb angle > 10° (OR = 0.011, 95%CI:0.001-0.234, P = 0.004), associated spinal cord anomalies (OR = 24.369, 95%CI:1.057-561.793, P = 0.046), and preoperative apical translation > 10 mm (OR = 0.012, 95%CI:0.000-0.438, P = 0.016) were influential factors in the progression of the main curve Cobb angle.
CONCLUSIONS: The one-stage posterior hemivertebra resection and short-segment corrective fusion with internal fixation are effective means to treat congenital scoliosis. However, attention should be paid to the loss of correction and curve progression during follow-up. Patients with spinal cord malformation and a large preoperative apical vertebra translation have a greater risk of losing the correction after surgery.
摘要：
背景：分析先天性脊柱侧凸患者一期后路半椎体切除术后矫正效果丧失的影响因素。矫形器,融合和内固定。
方法：39例先天性脊柱侧凸（CS）患者接受一期后路半椎体切除术，矫形器,回顾性收集河北省儿童医院融合内固定术患者的一般人口学信息。术前、术后影像学指标比较,包括脊柱的主要曲率的cobb角，分段Cobb角,代偿性头曲线，补偿曲线在尾侧，节段性脊柱后凸,日冕平衡,矢状平衡,胸椎后凸,腰椎前凸,和根尖椎骨翻译。采用相关分析法对影响判断和修正效果丧失的因素进行评价,并将相关指标纳入多因素物流回归中。
结果：就冠状平面的射线照相指标而言，与术前价值相比，术后主曲线Cobb角有显著改善(8.00°±4.62°vs.33.30°±9.86°),分段Cobb角(11.87°±6.55°vs.31.29°±10.03°),代偿性头颅曲线(6.22°±6.33°vs.14.75°±12.50°),尾侧补偿曲线(5.58°±3.43°vs.12.61°±8.72°),冠状平衡(10.95mm±8.65mmvs.13.52mm±11.03mm),和根尖椎骨平移（5.96mm±5.07mmvs.16.55mm±8.39mm)(均P<0.05)。在矢状平面上,在Segmentalkyposis角中观察到显着改善（7.60°±9.36°与21.89°±14.62°,与术前相比，P<0.05）。在最后一次随访中，节段后凸角度(6.09°±9.75°vs.21.89°±14.62°,P<0.05),胸椎后凸(26.57°±7.68°vs.24.06°±10.49°,P<0.05）和腰椎前凸（32.12°±13.15°vs.27.84°±16.68°,P<0.05)与术前部门比拟有统计学意义。相关分析表明,主曲线Cobb角的校正效果与固定段长度相关(rs=-0.318,P=0.048),术后节段Cobb角(rs=-0.600,P<0.001),术前根尖椎体平移(rs=0.440,P=0.005),脊髓畸形（rs=-0.437，P=0.005）。节段性脊柱后凸的矫正效果与年龄相关(rs=0.388,P=0.037)。多因素logistic回归分析结果显示,术后节段Cobb角>10°(OR=0.011,95CI:0.001-0.234,P=0.004),相关脊髓异常(OR=24.369,95CI:1.057-561.793,P=0.046),术前根尖平移>10mm（OR=0.012，95CI：0.000～0.438，P=0.016）是主曲线Cobb角进展的影响因素。
结论：一期后路半椎体切除和短节段矫正融合内固定是治疗先天性脊柱侧凸的有效手段。然而,随访中应注意校正损失和曲线进展。脊髓畸形和术前根尖椎骨大平移的患者在手术后失去矫正的风险更大。
方法：39例先天性脊柱侧凸（CS）患者接受一期后路半椎体切除术，矫形器,回顾性收集河北省儿童医院融合内固定术患者的一般人口学信息。术前、术后影像学指标比较,包括脊柱的主要曲率的cobb角，分段Cobb角,代偿性头曲线，补偿曲线在尾侧，节段性脊柱后凸,日冕平衡,矢状平衡,胸椎后凸,腰椎前凸,和根尖椎骨翻译。采用相关分析法对影响判断和修正效果丧失的因素进行评价,并将相关指标纳入多因素物流回归中。
结果：就冠状平面的射线照相指标而言，与术前价值相比，术后主曲线Cobb角有显著改善(8.00°±4.62°vs.33.30°±9.86°),分段Cobb角(11.87°±6.55°vs.31.29°±10.03°),代偿性头颅曲线(6.22°±6.33°vs.14.75°±12.50°),尾侧补偿曲线(5.58°±3.43°vs.12.61°±8.72°),冠状平衡(10.95mm±8.65mmvs.13.52mm±11.03mm),和根尖椎骨平移（5.96mm±5.07mmvs.16.55mm±8.39mm)(均P<0.05)。在矢状平面上,在Segmentalkyposis角中观察到显着改善（7.60°±9.36°与21.89°±14.62°,与术前相比，P<0.05）。在最后一次随访中，节段后凸角度(6.09°±9.75°vs.21.89°±14.62°,P<0.05),胸椎后凸(26.57°±7.68°vs.24.06°±10.49°,P<0.05）和腰椎前凸（32.12°±13.15°vs.27.84°±16.68°,P<0.05)与术前部门比拟有统计学意义。相关分析表明,主曲线Cobb角的校正效果与固定段长度相关(rs=-0.318,P=0.048),术后节段Cobb角(rs=-0.600,P<0.001),术前根尖椎体平移(rs=0.440,P=0.005),脊髓畸形（rs=-0.437，P=0.005）。节段性脊柱后凸的矫正效果与年龄相关(rs=0.388,P=0.037)。多因素logistic回归分析结果显示,术后节段Cobb角>10°(OR=0.011,95CI:0.001-0.234,P=0.004),相关脊髓异常(OR=24.369,95CI:1.057-561.793,P=0.046),术前根尖平移>10mm（OR=0.012，95CI：0.000～0.438，P=0.016）是主曲线Cobb角进展的影响因素。
结论：一期后路半椎体切除和短节段矫正融合内固定是治疗先天性脊柱侧凸的有效手段。然而,随访中应注意校正损失和曲线进展。脊髓畸形和术前根尖椎骨大平移的患者在手术后失去矫正的风险更大。
