| ObjectiveTo analyze the risk factors of post-Coronal ImBalance of patients with Lenke type 5 AIS.To research the changes of cervical sagittal alignment(CSA)after surgery;To analyze the risk factors ofProximal Junctional Kyphosis(PJK)after surgery in patients with Lenke type 5 AIS.Methods1?Clinical data of 43 patients with Lenke 5 adolescent idiopathic scoliosis(AIS)admitted to the Department of Spinal Surgery,PLAG Hospital from July 2011 to July 2017 were retrospectively analyzed.According to the postoperative C7PL-CSVL,patients were divided into the coronal imbalance(CIB)group with the and the postoperative C7PL-CSVL>20mm,and the coronal balance(CB)group with the postoperative C7PL-CSVL<20mm.T-test and continuity correction chi-square test was used to analyze the differences between parameters.Pearson correlation analysis was used to analyze the correlation between postoprative C7PL-CSVL and other parameters.2?Clinical data of 43 patients with Lenke 5 adolescent idiopathic scoliosis(AIS)admitted to the Department of Spinal Surgery,PLAG Hospital from July 2011 to July 2017 were retrospectively analyzed.Cervical lordosis(CL)?thoracic kyphosis(TK)?thoracolumbar kyphosis(TLK)?Lumbar lordosis(LL)?lordosis in fusion(LIF)and C7 sagittal vertical axis(SVA)were measured from lateral X-ray film at preoperation.postoperation and last follow-up.The general parameters of patients include gender?age?Risser score?last follow-up month?the Number of Vertebras in Fusion segment(NVF)and TL/L Curve(TL/L C).According to the cervical sagittal alignment lordosis at preoperation,patients were divided into the Lordotic Group(L group,CL<0°)and Kyphotic Group(K group,CL?0°);According to the change of cervical sagittal alignment at last follow-up VS preoperation,patients were divided into the Lordosis Increased Group(I group)and the Lordosis Decreased Group(D group).T-test was used to analyze the difference between parameters of L and K,I and D groups.LSD-t test was used to analyze the difference between parameters at preoperation,postoperation and last follow-up.Pearson correlation test was used to analyze the correlation between CL and corresponding parameters in I and D group.We difined a=0.05 in the two-sided test.3?Clinical data about 33 patients with Lenke 5 type adolescent idiopathic scoliosis(AIS)admitted to the Department of Spinal Surgery from March 2012 to December 2016 were retrospectively analyzed.Patients with final PJA 10 more than pre-PJA were divided into the PJK(Proximal Junctional Kyphosis)group,while others were divided into the Non-PJK group.T-test and Wilcoxon-test were used to analyze the difference between the research indicators at pre-operation and last follow-up.Chi-square test was used to analyze the differents between the categorical data.Spearman correlation test were used to analyze the correlation between PJK and corresponding parameters.Results1?10 male patients and 33 female patients with an average age of 15.8 years were recruited in this study.17 patients(39.53%)with postoperative CIB got CB at last follow-up.Statistical difference was found between the pre-and post TL/L C?TC?C7PL-CSVL in all patients,CIB group and CB group.There was no difference in celection of LIV between the two groups.There were 3 patients in CIB group and 15 patients in CB group with post-LIV Tilt ?6°?Statistical difference was found between the post-and final LIV Tilt in CIB group and also was found between the pre-and post-DDA in both CIB&CB groups.ADDA was lager than APDA in all.There were 6 patients in CIB group and 1 patients in CB group with post-DDA opened to the concave side of the main curve.Postoperative C7PL-CSVL was correlated with post-DDA?post-L5 CR and L5 FR.2?43 patients,10 male and 33 female,with the age of 15.8years and last follow-up month of 22.8 were divided into L group(n=15)&K group(n=17)preoperatively and into I group(n=26)&D group(n=17)at last follow-up.No statistically significant difference was found between the general parameters of patients in L&K groups and in I&D groups.In all patients,the final TK was increased compared to preoperative TK(p=0.000);the postoperative TLK was statistically different with preoperative TLK(P=0.000)and no statistically significant difference was found between preoperative,postoperative and final CL.Subgroup comparisons between groups L and K showed significant difference(P<0.05)in preoperative CL(P=0.000),LIF(P=0.029)and SVA(P=0.003).Intra-group comparisons in group K showed increased CL(P=0.025)and TK(P=0.000)at last follow-up,which also showed smaller postoperative TLK(P=0.002)that continued to last follow-up(P=0.002).Subgroup comparisons between groups I and D showed significant difference(P<0.05)in preoperative LL(P==0.043)and CL(P=0.000).Final CL was increased compared to preoperative(P=0.008)and TK was increased compared to preoperative(P=0.000)and postoperative(P=0.001)in group I.Smaller TLK at postoperation than at preoperation(P=0.005)kept to last follow-up(P=0.006)in I group.Lager LL at postoperation than at preoperation(P=0.011)kept to last follow-up(P=0.001)was also observed in D group.There was a correlation between CL and TK,SVA preoperatively in group I.CL was also correlated with LL and SVA preoperatively,with TLK and SVA postperatively and with TLK at last follow-up in group D.3?There were 12 petients with 3 male and 9 female in PJK group and the average age was 13.58years old.There were 21 patients with 5 male and 16 female in Non-PJK group and the average age was 15.19 years old.No statistically significant difference was found in general statistics of both groups.Significant difference was observed in preoperative and final TK,PJA,LL,LIF,PI-LL,TL/LC,TC of PJK group and in preoperative and final TK,TLK,LIF,TL/LC,TC of Non-PJK group.The final TK,PJA,LL,PI-LL of both groups were significantly deferent.PJK was correlated with TK(r=0.805,P=0.000)?TLK(r=0.397,P=0.022)?LUF(r=-0.357,P=0.042)?PI-LL(r=-0.528,P=0.002)?LL(r=-0.364,P=0.037)respectively at last follow-up.Conclusionspart1:1.Patients with post-LIV Tilt?6° may get lower incidence of CIB postoperatively;2.Post-DDA opened to the concave side of the main curve may be one risk factor of post-CIB;3.Lager preoperative C7PL-CSVL may be another risk factor of post-CIB.Part2:1.Patients with kyphotic pre-CSA have their CL improved significantly at last follow-up.2.Increased TK during follow-up and appropriate post-TLK might result in improved CSA finally.3.Increased post-LL without the change of TK or TLK might not result in improved CSA finally.Part3:1.Higher postoperative TK and LL maybe the potential risk factors of PJK after TL/L posterior fusion in patients with Lenke type 5 AIS.2.Intraoperative decrease in TLK and suitable postoperative LL according to PI may decrease the incidents of PJK during the follow-up. |
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