背景:先前的研究表明,T1倾斜与术后肩部平衡(SB)呈正相关。这项研究的目的是探讨术中T1倾斜的作用,作为预测青少年特发性脊柱侧凸(AIS)患者术后SB的潜在参数。
方法:从一个三级中心对具有结构性胸曲线的AIS患者进行了至少2年随访。术前站立,第1架设,1年和2年的随访;以及术中最终易发的X光片以及临床数据进行了审查。将患者分为2组:A组-最终术中T1倾斜≤5°,B组-最终术中T1倾斜>5°。对于基线右肩或左肩高以及UIV为T2或T3/T4的患者,将这些组的术后SB整体和单独进行比较。就多个SB变量而言,将2年时最佳SB(X线摄影肩高(RSH)<2cm)的患者与次优SB(RSH≥2cm)进行比较。
结果:55名患者(平均年龄15.1岁,43F,包括平均BMI22,平均胸廓Cobb-49.8°)。根据伦克曲线类型,有13名1A型患者,10例患者为1B,12例1C,7名2A患者,2B型患者4例,3C型患者9例。T1倾斜与RSH显著相关,锁骨角度差(CAD),第一肋角片(FRA),UIV在最初直立时倾斜,1年,和术后2年的X光片(全部p<0.05)。比较群体时,A和B,A组患者的2年SB参数恢复明显更好;RSH(6.8vs11.8mm,p=0.01),CAD(3.9vs9.1p<0.001)和T1倾斜(4.7vs7.8°p=0.01)。对于基线右肩高的患者发现了类似的结果;RSH(p=0.04),CAD(p<0.001)和T1倾斜(p<0.001)以及UIV是否为T2或T3/T4。尽管MTCobb校正无差异,但与47例最佳SB患者相比,8例次最佳SB患者的术中T1倾斜较差(p=0.03)(83.1vs79.8%,p=0.57)。
结论:术后T1倾斜与首次直立侧肩参数相关,1年,和2年X光片.因此,T1倾斜可以潜在地用作预测术后SB的替代。无论UIV是T2还是T3/T4,术中T1倾斜≤5°的水平都与术后2年的肩部平衡参数有关。尽管所有患者的主胸曲线校正百分比相似,但2年时SB次优的患者最终术中T1倾斜较差。
BACKGROUND: Previous studies have shown that T1 tilt is positively correlated with post-operative shoulder balance (SB). The aim of this study was to explore the role of intra-operative T1 tilt, among other shoulder parameters as a potential parameter to predict post-operative SB in adolescent
idiopathic scoliosis (AIS) patients.
METHODS: A retrospective review of AIS patients with structural thoracic curves with minimum 2 year follow up was conducted from a single tertiary center. Standing pre-operative, 1st erect, 1 year and 2-year follow-up; and intra-operative final prone radiographs were reviewed along with clinical data. Patients were stratified into 2 cohorts: Group A-Final intra-operative T1 tilt ≤5° and Group B-Final intra-operative T1 tilt >5°. These groups were compared for post-operative SB as a whole and separately for patients with baseline right or left shoulder high and if UIV was T2 or T3/T4. Patients with optimal SB (Radiographic shoulder height (RSH) <2 cm) at 2 years were compared to sub-optimal SB (RSH ≥ 2 cm) with respect to multiple SB variables.
RESULTS: 55 patients (mean age 15.1 years-old, 43 F, mean BMI 22, mean thoracic Cobb-49.8°) were included. Based on Lenke curve types, there were 13 patients with type 1A, 10 patients with 1B, 12 patients with 1C, 7 patients with 2A, 4 patients with 2B and 9 patients with type 3C. T1 tilt was significantly correlated with RSH, Clavicle angle difference (CAD), First Rib Angle (FRA), and UIV tilt at first erect, 1-year, and 2-year post-op radiographs (p < 0.05 for all). When comparing groups, A and B, Group A patients showed significantly better restoration of their 2-year SB parameters; RSH (6.8 vs 11.8 mm, p = 0.01), CAD (3.9 vs 9.1 p < 0.001) and T1 tilt (4.7 vs 7.8° p = 0.01). Similar results were found for patients with baseline right shoulder high; RSH (p = 0.04), CAD (p < 0.001) and T1 tilt (p < 0.001) and whether UIV was T2 or T3/T4. Eight patients with sub-optimal SB had worse intra-operative T1 tilt (p = 0.03) compared to 47 patients with optimal SB despite no difference in MT Cobb correction (83.1 vs 79.8%, p = 0.57).
CONCLUSIONS: Post-operative T1 tilt correlates with lateral shoulder parameters at first erect, 1 year, and 2-year radiographs. Therefore, T1 tilt can potentially be used as a surrogate to predict post-operative SB. Leveling intra-operative T1 tilt ≤5° is associated with better 2-year post-operative shoulder balance parameters irrespective of whether the UIV was T2 or T3/T4. Patients with sub-optimal SB at 2 years had worse final intra-operative T1 tilt despite similar percent correction of main thoracic curve for all patients.