Lenke type 1の特発性側弯症に対するVertebral Coplanar Alignment（VCA）法における術後肩バランス不良の発生に関係する因子の検討
はじめに：側弯症の術後肩バランス不良（PSI）はQOLに影響する．肩バランスはRadiographic shoulder height（RSH）やT1 tiltで評価されるが，それらの値を規定する因子は不明である．Vertebral coplanar alignment（VCA）におけるRSHとT1 tiltを規定する因子を検討した．対象と方法：11施設においてVCA法で矯正固定術を行ったLenke type 1患者76例を対象とした．術前・術後のRSHとT1 tiltの変化量（ΔRSH，ΔT1 tilt）とその他のパラメータの相関係数を解析した．結果：近位胸椎カーブ（PTC）flexibil...
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| Published in | Journal of Spine Research Vol. 16; no. 1; pp. 39 - 47 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脊椎脊髄病学会
20.01.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1884-7137 2435-1563 |
| DOI | 10.34371/jspineres.2023-0043 |
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| Abstract | はじめに：側弯症の術後肩バランス不良（PSI）はQOLに影響する．肩バランスはRadiographic shoulder height（RSH）やT1 tiltで評価されるが，それらの値を規定する因子は不明である．Vertebral coplanar alignment（VCA）におけるRSHとT1 tiltを規定する因子を検討した．対象と方法：11施設においてVCA法で矯正固定術を行ったLenke type 1患者76例を対象とした．術前・術後のRSHとT1 tiltの変化量（ΔRSH，ΔT1 tilt）とその他のパラメータの相関係数を解析した．結果：近位胸椎カーブ（PTC）flexibilityはΔRSHと弱い負の相関を示した．PTC矯正率は術前から術後2年のΔT1 tiltで弱い負の相関を示した．主胸椎カーブ（MTC）の頂椎変化量（ΔMT-AVT）は術前から術直後のΔRSH，ΔT1 tiltでは術直後・術後2年ともに正の弱い相関を示した．結語：ΔMT-AVTがΔRSH・ΔT1 tiltを規定する因子であり，肩バランスを調整する術中評価を行う指標と考える． |
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| AbstractList | はじめに：側弯症の術後肩バランス不良（PSI）はQOLに影響する．肩バランスはRadiographic shoulder height（RSH）やT1 tiltで評価されるが，それらの値を規定する因子は不明である．Vertebral coplanar alignment（VCA）におけるRSHとT1 tiltを規定する因子を検討した．対象と方法：11施設においてVCA法で矯正固定術を行ったLenke type 1患者76例を対象とした．術前・術後のRSHとT1 tiltの変化量（ΔRSH，ΔT1 tilt）とその他のパラメータの相関係数を解析した．結果：近位胸椎カーブ（PTC）flexibilityはΔRSHと弱い負の相関を示した．PTC矯正率は術前から術後2年のΔT1 tiltで弱い負の相関を示した．主胸椎カーブ（MTC）の頂椎変化量（ΔMT-AVT）は術前から術直後のΔRSH，ΔT1 tiltでは術直後・術後2年ともに正の弱い相関を示した．結語：ΔMT-AVTがΔRSH・ΔT1 tiltを規定する因子であり，肩バランスを調整する術中評価を行う指標と考える． |
| Author | 森平, 泰 片柳, 順也 友利, 正樹 新井, 秀和 永井, 琢哉 豊田, 宏光 志村, 有永 中村, 英一郎 明田, 浩司 野尻, 英俊 高田, 知史 伊藤, 研悠 森野, 忠夫 近藤, 直也 山田, 勝祟 種市, 洋 大谷, 和之 |
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| References | 1) Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg Am. 1983; 65: 447-455 2) Smyrnis PN, Sekouris N, Papadopoulos G: Surgical assessment of the proximal thoracic curve in adolescent idiopathic scoliosis. Eur Spine J. 2009; 18: 522-530 3) Asher M, Lai SM, Burton D, et al: The influence of spine and trunk deformity on preoperative idiopathic scoliosis patients' health-related quality of life questionnaire responses. Spine (Phila Pa 1976). 2004; 29: 861-868 5) Banno T, Yamato Y, Hasegawa T, et al: Preoperative Less Right Shoulder Elevation Had a Higher Risk of Postoperative Shoulder Imbalance When Main Thoracic Curve Shows Higher Correction Regardless of the Upper Instrumented Vertebra Level for Patients with Adolescent Idiopathic Scoliosis Lenke Type 1. Asian Spine J. 2022. doi: 10.31616/asj.2022.0020 7) Qiu Y, Zhu F, Wang B, et al: Comparison of surgical outcomes of lenke type 1 idiopathic scoliosis: vertebral coplanar alignment versus derotation technique. J Spinal Disord Tech. 2011; 24: 492-499 11) Kuklo TR, Lenke LG, Won DS, et al: Spontaneous proximal thoracic curve correction after isolated fusion of the main thoracic curve in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2001; 26: 1966-1975 13) Trobisch PD, Ducoffe AR, Lunner BS, et al: Choosing fusion levels in adolescent idiopathic scoliosis. J Am Acad Orthop Surg. 2013; 21: 519-528 6) Vallespir GP, Flores JB, Trigueros IS, et al: Vertebral coplanar alignment: a standardized technique for three dimensional correction in scoliosis surgery: technical description and preliminary results in Lenke type 1 curves. Spine (Phila Pa 1976). 2008; 33: 1588-1597 15) Zhang S, Zhang L, Feng X, et al: Incidence and risk factors for postoperative shoulder imbalance in scoliosis: a systematic review and meta-analysis. Eur Spine J. 2018; 27: 358-369 12) Wei Chan CY, Chiu CK, Ng YH, et al: An analysis of preoperative shoulder and neck balance and surgical outcome in 111 adolescent idiopathic scoliosis patients with two subtypes of Lenke 1 curves. J Neurosurg Spine. 2020; 34: 37-44 14) Ilharreborde B, Even J, Lefevre Y, et al: How to determine the upper level of instrumentation in Lenke types 1 and 2 adolescent idiopathic scoliosis: a prospective study of 132 patients. J Pediatr Orthop. 2008; 28: 733-739 16) Gajaseni P, Labianca L, Kalakoti P, et al: Achieving Shoulder Balance Using Medial and Lateral Radiological Measures in Adolescent Idiopathic Scoliosis. Iowa Orthop J. 2022; 42: 47-51 8) Ono T, Bastrom TP, Newton PO: Defining 2 components of shoulder imbalance: clavicle tilt and trapezial prominence. Spine (Phila Pa 1976). 2012; 37: E1511-1516 10) Smith PL, Donaldson S, Hedden D, et al: Parents' and patients' perceptions of postoperative appearance in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2006; 31: 2367-2374 4) Matsumoto M, Watanabe K, Kawakami N, et al: Postoperative shoulder imbalance in Lenke Type 1A adolescent idiopathic scoliosis and related factors. BMC Musculoskelet Disord. 2004; 15: 366 9) Hong JY, Suh SW, Yang JH, et al: Reliability analysis of shoulder balance measures: comparison of the 4 available methods. Spine (Phila Pa 1976). 2013; 38: E1684-1690 |
| References_xml | – reference: 2) Smyrnis PN, Sekouris N, Papadopoulos G: Surgical assessment of the proximal thoracic curve in adolescent idiopathic scoliosis. Eur Spine J. 2009; 18: 522-530 – reference: 3) Asher M, Lai SM, Burton D, et al: The influence of spine and trunk deformity on preoperative idiopathic scoliosis patients' health-related quality of life questionnaire responses. Spine (Phila Pa 1976). 2004; 29: 861-868 – reference: 12) Wei Chan CY, Chiu CK, Ng YH, et al: An analysis of preoperative shoulder and neck balance and surgical outcome in 111 adolescent idiopathic scoliosis patients with two subtypes of Lenke 1 curves. J Neurosurg Spine. 2020; 34: 37-44 – reference: 8) Ono T, Bastrom TP, Newton PO: Defining 2 components of shoulder imbalance: clavicle tilt and trapezial prominence. Spine (Phila Pa 1976). 2012; 37: E1511-1516 – reference: 5) Banno T, Yamato Y, Hasegawa T, et al: Preoperative Less Right Shoulder Elevation Had a Higher Risk of Postoperative Shoulder Imbalance When Main Thoracic Curve Shows Higher Correction Regardless of the Upper Instrumented Vertebra Level for Patients with Adolescent Idiopathic Scoliosis Lenke Type 1. Asian Spine J. 2022. doi: 10.31616/asj.2022.0020 – reference: 11) Kuklo TR, Lenke LG, Won DS, et al: Spontaneous proximal thoracic curve correction after isolated fusion of the main thoracic curve in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2001; 26: 1966-1975 – reference: 16) Gajaseni P, Labianca L, Kalakoti P, et al: Achieving Shoulder Balance Using Medial and Lateral Radiological Measures in Adolescent Idiopathic Scoliosis. Iowa Orthop J. 2022; 42: 47-51 – reference: 13) Trobisch PD, Ducoffe AR, Lunner BS, et al: Choosing fusion levels in adolescent idiopathic scoliosis. J Am Acad Orthop Surg. 2013; 21: 519-528 – reference: 4) Matsumoto M, Watanabe K, Kawakami N, et al: Postoperative shoulder imbalance in Lenke Type 1A adolescent idiopathic scoliosis and related factors. BMC Musculoskelet Disord. 2004; 15: 366 – reference: 15) Zhang S, Zhang L, Feng X, et al: Incidence and risk factors for postoperative shoulder imbalance in scoliosis: a systematic review and meta-analysis. Eur Spine J. 2018; 27: 358-369 – reference: 1) Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg Am. 1983; 65: 447-455 – reference: 6) Vallespir GP, Flores JB, Trigueros IS, et al: Vertebral coplanar alignment: a standardized technique for three dimensional correction in scoliosis surgery: technical description and preliminary results in Lenke type 1 curves. Spine (Phila Pa 1976). 2008; 33: 1588-1597 – reference: 10) Smith PL, Donaldson S, Hedden D, et al: Parents' and patients' perceptions of postoperative appearance in adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2006; 31: 2367-2374 – reference: 7) Qiu Y, Zhu F, Wang B, et al: Comparison of surgical outcomes of lenke type 1 idiopathic scoliosis: vertebral coplanar alignment versus derotation technique. J Spinal Disord Tech. 2011; 24: 492-499 – reference: 9) Hong JY, Suh SW, Yang JH, et al: Reliability analysis of shoulder balance measures: comparison of the 4 available methods. Spine (Phila Pa 1976). 2013; 38: E1684-1690 – reference: 14) Ilharreborde B, Even J, Lefevre Y, et al: How to determine the upper level of instrumentation in Lenke types 1 and 2 adolescent idiopathic scoliosis: a prospective study of 132 patients. J Pediatr Orthop. 2008; 28: 733-739 |
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| Snippet | はじめに：側弯症の術後肩バランス不良（PSI）はQOLに影響する．肩バランスはRadiographic shoulder height（RSH）やT1 tiltで評価されるが，それらの値を規定する因子は不明である．Vertebral coplanar alignment（VCA）におけるRSHとT1... |
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| SubjectTerms | Lenke type 1 Vertebral Coplanar Alignment（VCA）法 術後肩バランス不良 |
| Title | Lenke type 1の特発性側弯症に対するVertebral Coplanar Alignment（VCA）法における術後肩バランス不良の発生に関係する因子の検討 |
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