PDF(Pubmed)
Abstract：
BACKGROUND: Surgery to correct spinal deformities in scoliosis involves the use of contoured rods to reshape the spine and correct its curvatures. It is crucial to bend these rods appropriately to achieve the best possible correction. However, there is limited research on how the rod bending process relates to spinal shape in adolescent idiopathic scoliosis surgery.
METHODS: A retrospective study was conducted using a prospective multicenter scoliosis database. This study included adolescent idiopathic scoliosis patients from the database who underwent surgery with posterior instrumentation covering the T4 to T12 segments. Standing global spine X-rays were used in the analysis. The sagittal Cobb angles between T5 and T11 were measured on the spine. Additionally, the curvature of the rods between T5 and T11 was measured using the tangent method. To assess the relationship between these measurements, the difference between the dorsal kyphosis (TK) and the rod kyphosis (RK) was calculated (ΔK = TK - RK). This study aimed to analyze the correlation between ΔK and various patient characteristics. Both descriptive and statistical analyses were performed to achieve this goal.
RESULTS: This study encompassed a cohort of 99 patients, resulting in a total of 198 ΔK measurements for analysis. A linear regression analysis was conducted, revealing a statistically significant positive correlation between the kyphosis of the rods and that of the spine (r = 0.77, p = 0.0001). On average, the disparity between spinal and rod kyphosis averaged 5.5°. However, it is noteworthy that despite this modest mean difference, there was considerable variability among the patients. In particular, in 84% of cases, the concave rod exhibited less kyphosis than the spine, whereas the convex rod displayed greater kyphosis than the spine in 64% of cases. It was determined that the primary factor contributing to the flattening of the left rod was the magnitude of the coronal Cobb angle, both before and after the surgical procedure. These findings emphasize the importance of considering individual patient characteristics when performing rod bending procedures, aiming to achieve the most favorable outcomes in corrective surgery.
CONCLUSIONS: Although there is a notable and consistent correlation between the curvature of the spine and the curvature of the rods, it is important to acknowledge the substantial heterogeneity observed in this study. This heterogeneity suggests that individual patient factors play a significant role in shaping the outcome of spinal corrective surgery. Furthermore, this study highlights that more severe spinal curvatures in the frontal plane have an adverse impact on the shape of the rods in the sagittal plane. In other words, when the scoliosis curve is more pronounced in the frontal plane, it tends to influence the way the rods are shaped in the sagittal plane. This underscores the complexity of spinal deformities and the need for a tailored approach in surgical interventions to account for these variations among patients.
METHODS: A retrospective study was conducted using a prospective multicenter scoliosis database. This study included adolescent idiopathic scoliosis patients from the database who underwent surgery with posterior instrumentation covering the T4 to T12 segments. Standing global spine X-rays were used in the analysis. The sagittal Cobb angles between T5 and T11 were measured on the spine. Additionally, the curvature of the rods between T5 and T11 was measured using the tangent method. To assess the relationship between these measurements, the difference between the dorsal kyphosis (TK) and the rod kyphosis (RK) was calculated (ΔK = TK - RK). This study aimed to analyze the correlation between ΔK and various patient characteristics. Both descriptive and statistical analyses were performed to achieve this goal.
RESULTS: This study encompassed a cohort of 99 patients, resulting in a total of 198 ΔK measurements for analysis. A linear regression analysis was conducted, revealing a statistically significant positive correlation between the kyphosis of the rods and that of the spine (r = 0.77, p = 0.0001). On average, the disparity between spinal and rod kyphosis averaged 5.5°. However, it is noteworthy that despite this modest mean difference, there was considerable variability among the patients. In particular, in 84% of cases, the concave rod exhibited less kyphosis than the spine, whereas the convex rod displayed greater kyphosis than the spine in 64% of cases. It was determined that the primary factor contributing to the flattening of the left rod was the magnitude of the coronal Cobb angle, both before and after the surgical procedure. These findings emphasize the importance of considering individual patient characteristics when performing rod bending procedures, aiming to achieve the most favorable outcomes in corrective surgery.
CONCLUSIONS: Although there is a notable and consistent correlation between the curvature of the spine and the curvature of the rods, it is important to acknowledge the substantial heterogeneity observed in this study. This heterogeneity suggests that individual patient factors play a significant role in shaping the outcome of spinal corrective surgery. Furthermore, this study highlights that more severe spinal curvatures in the frontal plane have an adverse impact on the shape of the rods in the sagittal plane. In other words, when the scoliosis curve is more pronounced in the frontal plane, it tends to influence the way the rods are shaped in the sagittal plane. This underscores the complexity of spinal deformities and the need for a tailored approach in surgical interventions to account for these variations among patients.
摘要：
背景：矫正脊柱侧凸脊柱畸形的手术涉及使用轮廓杆重塑脊柱并矫正其曲率。适当地弯曲这些杆以实现可能的最佳校正是至关重要的。然而,关于青少年特发性脊柱侧凸手术中杆弯曲过程与脊柱形状的关系的研究有限。
方法：使用前瞻性多中心脊柱侧凸数据库进行回顾性研究。这项研究包括数据库中的青少年特发性脊柱侧凸患者，他们接受了T4至T12节段的后部器械手术。在分析中使用站立的全球脊柱X射线。在脊柱上测量T5和T11之间的矢状Cobb角。此外,使用切线法测量T5和T11之间的杆的曲率。为了评估这些测量之间的关系，计算背侧后凸（TK）和杆状后凸（RK）之间的差异（ΔK=TK-RK）。本研究旨在分析ΔK与各种患者特征之间的相关性。进行描述性和统计分析以实现该目标。
结果：本研究包括99名患者，总共测量了198个ΔK，用于分析。进行了线性回归分析，揭示了杆的后凸与脊柱的后凸之间的统计学显着正相关（r=0.77，p=0.0001）。平均而言,脊柱和棒后凸之间的差异平均为5.5°。然而,值得注意的是，尽管均值差异很小，患者之间存在相当大的差异。特别是,在84%的案例中，凹杆的后凸比脊柱少，而在64％的病例中，凸杆显示出比脊柱更大的后凸。确定了导致左杆变平的主要因素是冠状Cobb角的大小，手术前后。这些发现强调了在执行棒弯曲手术时考虑个体患者特征的重要性。旨在在矫正手术中获得最有利的结果。
结论：尽管脊柱的曲率和杆的曲率之间存在显著且一致的相关性，重要的是要承认在这项研究中观察到的实质性异质性。这种异质性表明，个体患者因素在塑造脊柱矫正手术的结果中起着重要作用。此外，这项研究强调，额叶平面中更严重的脊柱弯曲会对矢状平面中棒的形状产生不利影响。换句话说,当脊柱侧凸曲线在额平面更明显时，它往往会影响杆在矢状面的形状。这强调了脊柱畸形的复杂性，以及在手术干预中需要量身定制的方法来解决患者之间的这些差异。
方法：使用前瞻性多中心脊柱侧凸数据库进行回顾性研究。这项研究包括数据库中的青少年特发性脊柱侧凸患者，他们接受了T4至T12节段的后部器械手术。在分析中使用站立的全球脊柱X射线。在脊柱上测量T5和T11之间的矢状Cobb角。此外,使用切线法测量T5和T11之间的杆的曲率。为了评估这些测量之间的关系，计算背侧后凸（TK）和杆状后凸（RK）之间的差异（ΔK=TK-RK）。本研究旨在分析ΔK与各种患者特征之间的相关性。进行描述性和统计分析以实现该目标。
结果：本研究包括99名患者，总共测量了198个ΔK，用于分析。进行了线性回归分析，揭示了杆的后凸与脊柱的后凸之间的统计学显着正相关（r=0.77，p=0.0001）。平均而言,脊柱和棒后凸之间的差异平均为5.5°。然而,值得注意的是，尽管均值差异很小，患者之间存在相当大的差异。特别是,在84%的案例中，凹杆的后凸比脊柱少，而在64％的病例中，凸杆显示出比脊柱更大的后凸。确定了导致左杆变平的主要因素是冠状Cobb角的大小，手术前后。这些发现强调了在执行棒弯曲手术时考虑个体患者特征的重要性。旨在在矫正手术中获得最有利的结果。
结论：尽管脊柱的曲率和杆的曲率之间存在显著且一致的相关性，重要的是要承认在这项研究中观察到的实质性异质性。这种异质性表明，个体患者因素在塑造脊柱矫正手术的结果中起着重要作用。此外，这项研究强调，额叶平面中更严重的脊柱弯曲会对矢状平面中棒的形状产生不利影响。换句话说,当脊柱侧凸曲线在额平面更明显时，它往往会影响杆在矢状面的形状。这强调了脊柱畸形的复杂性，以及在手术干预中需要量身定制的方法来解决患者之间的这些差异。
