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目的探讨置钉密度是否影响Lenk1型青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者冠状位和矢状位矫正效果。方法回顾性分析2008年1月至2010年1月,在同一中心手术治疗的31例采用后路全钉选择性融合的Lenke1型AIS患者术前、术后即刻和术后2年随访结果。记录患者的一般资料。采用Pearson相关分析置钉密度与冠状位Cobb’s角矫正率及矫正比率的关系,置钉密度与冠状面术后2年随访矫正角度丢失及矢状位角度变化的相关关系。根据置钉密度的高低将患者分为高密度组(>0.7)与低密度组(≤0.7),统计比较两组间相关参数的差异。结果术前平均年龄为15.3岁,术前主胸弯角度平均为(48.5±8.5)°,术后2周随访平均矫正至(16.0±6.9)°,冠状位平均矫正率为68%;手术即刻矫正率与植入螺钉密度的相关性为-0.19(P=0.315),矫正比率与植入螺钉密度的相关性为-0.10(P=0.589),冠状位矫正角度丢失与植入螺钉密度的相关性为-0.04(P=0.837);矢状位胸椎后凸术后角度减少与置钉密度相关性0.09(P=0.619)。高、低置钉密度两组平均植入物密度分别为0.85与0.61(P<0.01),其它参数两组间差异无统计学意义。结论无论是否考虑柔韧性因素,Lenke1型AIS胸弯冠状面矫正率与置钉密度无明显相关性,矢状位胸弯生理曲度的变化与置钉比例无关。冠状面矫正角度2年丢失及矢状位角度变化与置钉密度也无关。
Objective To investigate the effect of nail density on coronal and sagittal correction in patients with Lenk1 adolescent idiopathic scoliosis (AIS). Methods The clinical data of 31 patients with Lenke type 1 AIS who underwent selective allograft fusion in the same center from January 2008 to January 2010 were retrospectively analyzed. Results of preoperative, immediate and postoperative follow-up were retrospectively analyzed. Record patient’s general information. Pearson correlation analysis was used to analyze the relationship between the density of staples and the Cobb’s angle correction rate and the correction ratio. The correlation between nail density and the correction angle loss and the sagittal angle change at 2 years after coronal surgery was analyzed. The patients were divided into high-density group (> 0.7) and low-density group (≤0.7) according to the density of nailing. The differences of related parameters between the two groups were statistically compared. Results The average preoperative anterior age was 15.3 years. The average preoperative anastomosis of major thoracic curves was (48.5 ± 8.5) °. The average correction was (16.0 ± 6.9) ° at 2 weeks postoperatively. The mean coronal correction was 68% The correlation between the correction rate and implant screw density was -0.19 (P = 0.315). The correlativity was -0.10 (P = 0.589) with the implant screw density. The correlation between the loss of coronal correction angle and implant screw density Sex was -0.04 (P = 0.837); Sagittal thoracic kyphosis was associated with a reduction in nail angle of 0.09 (P = 0.619). The mean implant densities of high and low nail density groups were 0.85 and 0.61, respectively (P <0.01). There was no significant difference in other parameters between the two groups. Conclusions Correct correction rate of the Lenke type AIS has no correlation with nail density, regardless of whether the flexibility factor is taken into account. The change of physiological curvature of the sagittal chest has nothing to do with nail placement. 2 years of coronal correction angle loss and sagittal angle changes and nail density has nothing to do.