最下固定椎选择原理

DirectorDivision

of

Creative

InnovationsCenter

of

Excellent

in

Spine

ResearchTexas

Scottish

Rite

Hospital

(TSRH)Associate

ProfessorDepartment

of

OrthopedicSurgeryUniversity

of

Texas

Southwestern

MedicalCenterDallas,

Texas名誉脊柱脊髓损伤及畸形科医院Hong

Zhang,

M.D.AIS

最下固定椎的选择原理9th

CAOS,

May

19-22,

2016,

Chengdu,

China59°22°•AIS

Lenke

分型•Bending<25°

定义为非结构性弯；≥25°

为结构178220193779192223CSVLCSVLCSVLT1291°60°T12L530°CSVL3A

CurveL5T4CSVLT12L432°50°3B

Curve57°60°20°CSVL1C

Curve89°58°34⁰CSVL3C

Curve临床实践中的疑惑和问题非结构性腰弯一定不需要融合吗?结构性腰弯一定需要融合吗？腰弯Bending

25

度的规定有可能不能准确指导腰弯是否需要融合.腰弯顶椎与CSVL

的位置关系对腰弯是否需要融合可能会更有指导意义.86⁰64⁰CSVL>

1.2•Cobb

Ratio

=

T-Cobb

/

L-Cobb86

/

64

=

1.4

(>1.2)•AVT

Ratio

=

T-AVT

/

L-AVT64

/

27

=

2.4

(>1.2)•Rotation

Ratio

=

T-Rot

/

L-Rot2

/

1

=

2(>1.2)T-AVT64

mmL-AVT27

mmAdam’s

TestAdam’s

Test将问题理论化腰椎间距（

Lumbar

Gap,LG

）是指腰弯（或胸腰弯）顶椎凹侧缘到CSVL

的距离。-

顶椎体或顶椎间盘是腰弯凹侧缘到CSVL

的最远距离CSVL

触及腰弯的顶椎LG=

0

（腰修正弯A

或B

）建立假设证明理论•CSVLCSVLCSVL研究设计••••••••Methods176727176330178650192223Group

1LG

≤

10

mm38/119

(32%)Group

211

≤

LG

≤

15

mm23/119

(19%)Group

316

≤

LG

≤

20mm17/119

(14%)Group

4LG

≥

21

mm41/119

(34%)LG

=

9.1mmLG

=

14.3

mmLG

=19.2

mmLG

=31

mMethods医生回答：腰弯是否融合？60°(8°)Methods50MethodsPreop

EvaluationLGC7PL-CSVLTTST-Cobb

/

L-CobbT-AVT

/

L-AVTT-Rot

/L-RotL-BendingL-FILGC7PLTTSCSVL68°(44°)35%61°

(48°)21%Postop

EvaluationT-CorrectionrateL-Correction

rateC7PL-CSVLTTSShoulder

LevelGroup1LG

≤

10

mm204060800(%)Results100Group

211

≤

LG

≤

15

mmGroup

316

≤LG

≤20

mmGroup

4LG

≥

21

mm实际结果医生-1

判定医生-2

判定7%2%0%52%30%22%77%29%47%100%95%93%融合胸腰双弯ResultsPreop.融合胸弯（

n=51）融合胸腰双弯（n=68）P-ValueLG

(mm)9.6

±

3.925.0

±9.8<0.0001C7PL-CSVL

(mm)-14.3

±

9.7-24.4

±11.7<0.0001TTS(mm)-5.6

±

5.2-13.4±

8.60.0185T/L-Cobb

(%)1.3

±

0.111.0

±

0.16<0.0001T/L-AVT

(%)1.9

±

0.571.1

±

0.47<0.0001T/L-Rotation

(%)1.4

±

0.571.0

±

0.470.0002L-Bending

(°)17.3

±

12.023.4

±

11.20.0047ResultsPostop.

融合胸弯（

n=51

）融合胸腰双弯（

n=68

）

P-ValueT-Correction

rate(%)46.4

±

13.559.9

±

11.3<0.05L-Correction

rate(%)38.6

±

15.465.5

±

11.4<0.05C7PL-CSVL

(mm)-18.1

±

8.3-10.8

±

8.1<0.05TTS(mm)-13.1

±

6.4-9.4±

7.4NSCSVL1C57°

(22°)LG

=

9

mmCSVL1C57°

(20°)LG

=

31

mmCSVL3C58°

(34°)LG

=

7.3

mmCSVL3C75°

(43°)LG

=

36.1mm术后1

年2

个月随访：主胸弯矫正率54%，腰弯自发矫正率46%