| Objective(s):To retrospectively analyze the clinical imaging data of adult patients with degenerative scoliosis,to observe the changes of spinal parameters in adult patients with degenerative scoliosis,and to explore the correlation and trend of changes of spinal three-dimensional parameters under different degrees of deformity,so as to provide theoretical basis for the development and clinical treatment of ADS deformity Methods:The clinical data of 54 patients with ADS admitted to our hospital with complete data and 30 patients who visited the hospital for examination without imaging abnormalities during the same period between 01 2015 and 01 2021 were retrospectively analyzed;the former group of patients served as the ADS group and the latter group as the control group;19(35.2%)males and 35(64.8%)females in the ADS group,aged 61.46± 8.97 years old,11 males(36.7%)and 19 females(63.3%)in the control group,age 59.87±59.44 years old;all patients underwent full-length spine films and lumbar spine CT to measure the coronal cobb angle,parietal offset AVT,CBD,number of laterally convex vertebrae involved,sagittal vertical axis SVA,pelvic incidence angle PI,pelvic tilt angle in the patients’ full-length spine films PT,T1 pelvic angle TPA,sacral tilt angle SS,lumbar anterior lordosis LL,thoracic lordosis TK,number of rotated vertebrae,and parietal rotation angle AVR measured in CT;then the ADS group was divided into ADS balanced group(CBD ≤ 3 cm and SVA ≤ 5 cm)and ADS imbalanced group(CBD > 3 cm and or SVA > 5 cm)according to the size of CBD and SVA absolute values;all The data were processed using statistical software.Results:A total of 84 study subjects were included in this study,30 in the control group and 54 in the ADS group;PI mean(51.96±3.85)°;PT mean(13.46±3.09)°;SS mean(37.70±6.06)°;LL mean(30.29±9.31)°;TK mean(21.42±7.073)°;SVA mean((3.68±1.68)cm;TPA mean(14.26±4.67)°;cobb angle mean(61.46±8.97)° in the ADS group;AVT mean(2.62±1.49)cm;CBD mean(2.38±1.60)cm;number of lateral convex vertebrae involved mean(5.33±1.26)°;PI mean(46.39± 13.53)°;PT mean(23.30±9.62)°;SS mean(24.45±13.30)°;LL mean(25.27±16.87)°;TK mean(18.50±10.73)°;SVA mean(4.07±2.61)cm;TPA mean(22.10±11.64)°;AVR mean(16.45±6.67)°;number of rotated vertebrae 1-7,mean(3.41±1.06);differences between PI,PT,SS,TPA,and rotation angle in the control group compared with the ADS group(p<0.05);6 cases(23.1%)were male and 20 cases(76.9%)were female in the ADS balance group;age 49-80(60.00±8.96)years;cob(8.96)years;mean cobb angle(29.07±10.78)°;mean AVT(2.63±1.74)cm;mean CBD(1.62±0.73)cm;mean number of scoliosis vertebrae involved(5.23±1.28);mean PI(47.85±12.75)°;mean PT(20.89±7.92)°;mean SS(28.82±13.44)°;LL mean(33.09±17.03)°;TK mean(18.97±10.52)°;SVA mean(2.45±1.03)cm;TPA mean(17.64±8.36)°;AVR mean(16.89±6.32)°;and rotational vertebral body count mean(3.46±0.91);In the ADS imbalance group,there were 13 males(46.4%)and 15 females(53.6%);ages 46-78(62.82±8.92)years;coronal parameters: cobb angle mean(32.47±8.91)°;AVT mean(2.60±1.26)cm;CBD mean(3.08±1.86)cm;number of laterally convex vertebrae involved mean(5.43±1.26);sagittal parameters: mean PI(45.05±14.32)°;mean PT(25.53±10.61)°;mean SS(20.39±12.02)°;mean LL(18.01±13.29)°;mean TK(18.06±11.09)°;mean SVA(5.57±2.74)cm;TPA mean(26.25±12.81)°;horizontal plane parameters: average AVR(16.03±7.08)°;average number of rotated vertebrae(3.36±1.19);The results of pearson correlation analysis between the ADS balanced group and the ADS imbalanced group showed that the cobb angle in the coronal plane was positively correlated with AVR,AVT was positively correlated with AVR,AVT was positively correlated with the number of rotated vertebrae,and the number of vertebrae involved in scoliosis was positively correlated with the number of rotated vertebrae between the two groups at different degrees of deformity(p<0.05),and there was no significant correlation between the sagittal plane and the horizontal plane and the coronal plane(p >The results of multiple linear regression analysis showed that the regression coefficient B of cobb and AVR increased as the degree of deformity increased(B=0.179 in the ADS balanced group and B=0.265 in the ADS imbalanced group);the regression coefficient B of AVT and AVR increased(B=1.040 in the ADS balanced group and B=2.872 in the ADS imbalanced group);and the regression coefficient B of AVT and number of rotated vertebrae decreased(B=1.040 in the ADS balanced group and B=2.872 in the ADS imbalanced group).The regression coefficient B decreased(ADS balanced group B=0.472,ADS imbalanced group B=0.149);the regression coefficient B decreased(ADS balanced group B=0.349,ADS imbalanced group B=0.345),indicating that the AVR increased with each 1-unit increase in cobb or AVT as the degree of deformity increased;the AVT or lateral The increase in the number of rotated vertebrae became smaller with each1-unit increase in the number of engaged convex vertebrae Conclusion(s):As the coronal cobb angle or AVT of ADS increased,the AVR also increased,and the two were positively correlated;as the coronal AVT or the number of laterally convex vertebrae involved in ADS increased,the number of rotated vertebrae also increased,and the two were positively correlated;when the coronal cobb angle or AVT were similar,a greater degree of parietal rotation was more likely to produce spinal imbalance;when the number of laterally convex vertebrae involved or AVT were similar,fewer vertebrae were involved in rotation,and spinal imbalance was more likely to be producedObjective(s): To retrospectively analyze the data of adult patients with degenerative scoliosis,compare the efficacy of posterior long-segment orthopedic fixation and fusion(n≥3)and short-segment orthopedic fixation and fusion(n<3)in adult patients with degenerative scoliosis,analyze the preoperative and final follow-up imaging data and clinical symptoms,and discuss the indications and effects of the two treatment options to provide ideas for clinical treatmentMethods:This study retrospectively analyzed 42 patients with ADS admitted to our hospital from 01/01/2017 to 01/01/2021,of whom 18(42.9%)were male and 24(57.1%)were female,divided into 22 cases of LSF(n≥3)in the long segment fixed fusion group and 20 cases of SSF(n<3)in the short segment fixed fusion group according to the number of fixed fusion segments,and measured the patients’ preoperative and The patients’ coronal cobb angle,CBD,and SVA were measured in preoperative and final follow-up full-length spine films,intraoperative bleeding,operative time,length of hospital stay,and complications were counted,and preoperative and final follow-up visual analog scores(VAS)of low back pain and leg pain and Oswestry dysfunction index(ODI)were collected to evaluate the efficacy of surgery;and the results were statistically analyzed.Results:A total of 42 cases were included in this study,18 cases(42.9%)were male and 24 cases(57.1%)were female,age 44-79 years,mean(61.89±10.08)years;23cases(54.8%)had low back pain and lower limb numbness with claudication,19cases(45.2%)had low back pain with lower limb numbness without intermittent claudication;28 cases(66.7%)had combined diabetes mellitus The proportion of patients with hypertension and osteoporosis was 73.8% in 31 cases and 71.4% in 30 cases.The preoperative disease duration was 0.9-11 years,mean(5.2±4.1)years;22cases in LSF group,8(36.4%)males and 14(63.6%)females,age 62.96±8.49 years,20 cases in SSF group,10(50%)males and 10(50%)females,age 60.89±9.97 years1.Comparison of preoperative and postoperative data: coronal cobb,CBD,SVA and ODI,low back pain VAS,and leg pain VAS were statistically significant between the two groups(p< 0.05)2.Comparison of data between LSF and SSF groups: the number of fixed segments,bleeding volume,operation time,hospital stay,cobb(preoperative,improvement rate),CBD(preoperative,improvement rate),and SVA(preoperative,improvement rate)were statistically different between the two groups(p < 0.05),and age,low back pain VAS(preoperative,final,improvement rate),leg pain VAS(preoperative,final,improvement rate),and Oswestry dysfunction index(preoperative,last,improvement rate),cobb(last),CBD(last),and SVA(last)were not statistically different(p > 0.05)Conclusion(s):Both long-and short-segment posterior orthopedic fixation and fusion can achieve good clinical results in the treatment of ADS,and each has its own surgical indications,which need to be selected according to the individual patient’s situation;long-segment posterior orthopedic fixation and fusion is suitable for ADS patients with severe spinal deformity,spinal stiffness,asymmetric degeneration of multiple segments,and significant spinal stenosis,while short-segment posterior orthopedic fixation and fusion is suitable for ADS patients with accurate symptom localization,moderate spinal flexibility and stability,and who cannot tolerate prolonged surgery... |
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