Objective: To investigate the indications and surgical outcome of Cobb+1 to Cobb fusion strategy in Lenke 5C adolescent idiopathic scoliosis (AIS) patients with the lower lumbar apex. Methods: The clinical data of Lenke 5C AIS patients treated in Nanjing Drum Tower Hospital from August 2015 to December 2018 were retrospectively analyzed. The patients were followed-up for at least 2 years after surgery and treated with selective Cobb+1 to Cobb fusion strategy. The patients were divided into the normal lumbar apex group (apex location of the main curve was between T12 and L1) and the lower lumbar apex group (apex location of the main curve was below the disc of L1/L2). The occurrence of proximal decompensation in the two groups was compared. In addition, according to whether the patients had proximal decompensation at the last follow-up, the patients in the lower lumbar apex group were further divided into proximal decompensation group and non-decompensation group. The radiographic parameters and Scoliosis Research Society-22 (SRS-22) scores of the two groups were compared. Results: A total of 52 patients (19 cases in the normal lumbar apex group and 33 cases in the lower lumbar apex group), aged (15.3±1.6) years, were followed up for 2-5 (3.2±1.2) years. Six patients (6/19) in the normal lumbar apex group and 5 cases (15.2%) in the lower lumbar apex group showed proximal decompensation during follow-up, and the incidence was significantly higher in the normal lumbar apex group (P=0.034). Within the lower lumbar apex group, the patients with proximal decompensation (n=5) showed similar Risser grade, baseline thoracic Cobb angle, and main Cobb angle as those without proximal decompensation(n=28), and the differences were all not statistically significant (all P>0.05). However, the baseline thoracic/lumbar apical vertebra translation (AVT) ratio was significantly larger in patients with proximal decompensation (0.6±0.2 vs 0.4±0.2, P=0.042), but the postoperative upper instrumented vertebra (UIV) tilt angle was similar (4.5°±2.3° vs 6.2°±3.4°, P=0.312). Conclusion: Cobb+1 to Cobb fusion strategy, selecting UIV at 1 level above upper end vertebra (UEV), could be performed in Lenke 5C patients with the lower lumbar apex location. In addition, UIV could be selected at UEV+1 in patients with small baseline thoracic curve.
目的： 探索Cobb+1至Cobb融合策略在腰弯低顶椎的Lenke5C型青少年特发性脊柱侧凸（AIS）患儿中的适应证及其手术疗效。 方法： 回顾性分析2015年8月至2018年12月于南京大学医学院附属鼓楼医院治疗的Lenke 5C型AIS患儿的临床资料，患儿术后至少随访2年，采用选择性Cobb+1至Cobb融合策略治疗。所有患儿被分为腰弯正常顶椎组（主弯顶椎位置在T12和L1之间）和低顶椎组（主弯顶椎位置低于L1/L2椎间盘），比较两组患儿近端失代偿发生情况。此外，根据末次随访时患儿是否出现了近端失代偿，将低顶椎组的患者进一步分为近端失代偿组与无失代偿组。比较两组患儿相关影像学参数及术后生活质量等。 结果： 共52例患儿（正常顶椎组19例，低顶椎组33例），年龄（15.3±1.6）岁，术后随访2~5（3.2±1.2）年。在随访期间，正常顶椎组有6例（6/19）和低顶椎组有5例（15.2%）患儿出现近端失代偿，正常顶椎组的发生率更高（P=0.034）。在低顶椎组中，发生近端失代偿患儿（n=5）表现出与未出现近端失代偿患儿（n=28）相似的Risser分级、术前胸弯Cobb角和主弯Cobb角，差异均无统计学意义（均P>0.05）。然而，在近端失代偿患者中，术前胸椎/腰椎顶椎偏移（AVT）比值较无失代偿组大（0.6±0.2比0.4±0.2，P=0.042），但术后上固定椎（UIV）的倾斜角相似（4.5°±2.3°比6.2°±3.4°，P=0.312）。 结论： 对于顶椎位置在L1~2椎间盘以下，且术前无胸椎代偿弯的Lenke 5C型AIS患者推荐使用Cobb+1至Cobb的融合策略。.