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目的:观察以胸弯为主的青少年特发性脊柱侧凸(AIS)患者后路矫形术后肩部失平衡的发生情况,探讨其危险因素。方法:回顾性分析96例以胸弯为主的AIS患者的临床资料,Lenke分型为Lenke 1、2、3、4型,均为右胸弯且Cobb角<80°。男15例,女81例;年龄10~18岁,平均14.5岁。均采用后路椎弓根螺钉系统固定矫形,随访22~68个月,平均42.2个月。根据术后肩部平衡情况,将患者分为肩部平衡组和肩部失平衡组,分析比较两组患者的临床资料和影像学特点。结果:肩部失平衡患者17例,发生率为17.7%。单变量分析和Logistic回归分析的结果发现与术后肩部失平衡相关的3个独立因素为:术前锁骨角(OR=1.873,P=0.018)、术前主胸弯Cobb角(OR=2.222,P=0.028)和术后主胸弯Cobb角(OR=0.483,P=0.039)。其中锁骨角和术前主胸弯Cobb角为危险因素,术前锁骨角的正值越大,主胸弯角度越大,术后肩部失平衡的危险性越大;术后主胸弯Cobb角为保护因素,术后主胸弯残余角度较大时,能相对避免肩部失平衡的发生。结论:术前锁骨角为正性倾斜、主胸弯角度较大和术后主胸弯残余角度过小可能是AIS患者主胸弯矫正后肩部失平衡的独立危险因素。
OBJECTIVE: To observe the incidence of shoulder imbalance after posterior orthopedic surgery in adolescent patients with idiopathic thoracic spine (AIS), and to explore the risk factors. Methods: The clinical data of 96 patients with chest-predominant AIS were retrospectively analyzed. The Lenke type was Lenke type 1, 2, 3 and 4, both with right thoracic curve and Cobb angle <80 °. 15 males and 81 females; aged 10 to 18 years, mean 14.5 years old. All posterior pedicle screw fixation orthopedic system was followed up for 22 to 68 months with an average of 42.2 months. According to the postoperative shoulder balance, the patients were divided into shoulder balance group and shoulder imbalance group. The clinical data and imaging features of the two groups were analyzed and compared. Results: There were 17 cases of shoulder unbalanced patients, the incidence was 17.7%. Univariate analysis and Logistic regression analysis showed that the three independent factors related to postoperative shoulder imbalance were preoperative supraclavicular angle (OR = 1.873, P = 0.018), preoperative primary chest Cobb angle (OR = 2.222 , P = 0.028) and postoperative Cobb angle (OR = 0.483, P = 0.039). Including the angle of the clavicle and preoperative Cobb angle as the risk factor, the greater the positive value of the preoperative supraclavicular angle, the greater the angle of the main chest, the greater the risk of postoperative shoulder imbalance; postoperative main chest Cobb Cobb Angle as a protective factor, postoperative main chest residual angle larger, can relatively avoid the occurrence of shoulder imbalance. Conclusions: Preoperative supraclavicular oblique angle, large principal thoracic angle and residual remnant angle of main thoracic curve may be the independent risk factors for shoulder imbalance after AIS correction.