| ObjectiveThis study was aimed to investigate the effects of concomitant rib deformity(RD)on the postoperative correction and the global balance of spine in congenital scoliosis(CS)patients underwent simple scoliosis correction surgery.MethodsWe retrospectively collected and analyzed the medical records of 86 CS patients using all pedicle screw instrumentation scoliosis correction surgery in the First Affiliated Hospital of Zhengzhou University from January 2009 to December 2017,with a minimum 18 months follow-up.According to the presence or absence of rib deformity,all samples were divided into two control groups including Rib Deformity group(RD)and Non-rib Deformity group(NRD).The full-spine X-rays were taken for each patient during the preoperative,two weeks after surgery and the last follow-up,then images were collected and measured.Radiographic parameters we obtained including Cobb angle of the Main Curve(MC),C7 Plumb Line(C7PL),Centre Sacral Vertical Line(CSVL),Apical Vertebra Translation(AVT),Coronal Balance(CB),Thoracic Trunk Shift(TTS),Clavicle Angle(CA),Cobb Angle Decrease(CAD),Sagittal Vertical Axis(SVA),Thoracic Kyphosis(TK),Proximal Junctional Angle(PJA)and ΔPJA.Other basic information(age,gender,length of hospital stay,duration of operation,blood loss and blood transfusion)were also collected.Comparison between groups made by independent sample t test or Wilcoxon rank sum test and Fisher exact test.The Pearson chi-square test was used to compare the occurrence of postoperative imbalance complications between two groups,then confirming the influence of rib deformity on the orthopedic effect and physical balance of CS patients.Results86 samples included 30 males and 56 females.There were 52 patients in RD group(19 males vs.33 females,average age at operation was 10.81±6.78 years old)and 34 patients in NRD group(11 males vs.23 females,average age at operation was 12.12 ± 4.05 years old).The average follow-up time after operation was 3.27 years(1.5-7.4 years).The intraoperative blood transfusion volume in RD group was significantly higher than that in NRD group(1101.71 ± 820.02ml vs.717.27 ±547.35ml,P<0.05).There were no differences between the two groups in terms of gender,age,length of hospital stay,duration of surgery,and intraoperative blood loss(P>0.05).Similarly,no significant differences were found in preoperative imaging parameters between the two groups(P>0.05).Comparing two weeks after the operation,the Cobb angle of the coronal plane was larger in the RD group(32.48°±20.12° vs.23.32°±16.93°,P<0.05),and the Cobb angle decrease(CAD)which can reflect the effect of the correction was smaller(52.73±20.72%vs.67.43 ±14.03%,P<0.001).At the last follow-up,smaller spine sagittal plane balance(SVA)existed in the RD group(7.22± 30.34mm vs.-13.17± 36.06mm,P<0.05).At the same time,the coronal Cobb Angle Decrease(CAD)was still lower than that in NRD group(48.60±19.29%vs.59.15 ± 18.46%,P<0.05).It is worth noting that the change of Proximal Junctional Angle(ΔPJA)in RD group was significantly greater than that of NRD group(9.17± 8.18° vs.4.49 ± 6.27°,P<0.05).The incidence of sagittal Proximal Junctional Kyphosis(PJK)in the RD group was higher(34.62%vs.14.71%),The Pearson chi-square test confirmed that the difference between two groups was significant(P<0.05).ConclusionGenerally speaking,our study showed that CS patients with concomitant rib deformity undergoing single scoliosis correction operation had worse overall correction effect than patients with congenital scoliosis alone,Not only was the correction rate of Cobb Angle significantly reduced in the coronal plane,patients with rib deformities were also more likely to develop Proximal Junctional Kyphosis in the sagittal plane than those with congenital scoliosis alone. |
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