| Objective: The aim of this study is to investigate the therapeutic effect of spinal orthopedic surgery and the recovery of sagittal sequence of thoracic kyphosis,and to analyze the factors that can affect the restoration of thoracic kyphosis in the Lenke type I adolescent idiopathic scoliosis(AIS).Methods: The data of Lenke1 AIS patients who underwent posterior pedicle screw orthopedic surgery was collected.The parameters measured following indexes,Cobb angle,side-bending Cobb angle,cervical lordosis(CL),thoracic kyphosis(TK),lumbar lordosis(LL),pelvic incidence(PI),sacral slope(SS),pelvic tilt(PT),sagittal vertical axis(SVA),the center of C7 plumb line to the center sacral vertical line(C7-CSVL),correction rate,Ponte osteotomy,flexibility and screw density.The cases in this paper were separated into three groups in reference to the preoperative TK;the thoracic hypokyphosis group(TK <20°),the normal kyphosis group(TK 20°-40°)and the thoracic hyperkyphosis group(TK >40°).Additionally,all Lenke type I AIS were separated into two groups in reference to the postoperative TK;Group A(postoperative TK <20°)and Group B(postoperative TK 20°-40°).Univariate analysis and multivariate Logistic regression analysis were performed.Results: Among the 43 cases analyzed,there were 25 males and 18 females.There were 35 cases of Lenke type 1A,2 cases of Lenke type 1B,and 6 cases of Lenke type 1C at least 1 year of follow-up.The mean age,mean Risser sign,mean operation time,and mean follow-up period were 14.70±2.47 years(11-19 years),2.12± 1.48°,34.84±19.77 months(12-74 months)and169.84±36.60 minutes.The mean preoperative Cobb angle,C7-CSVL,SVA,CL,TK,LL,PI,SS and PT were respectively 62.65±15.80°,15.90±9.38 mm,30.01±19.11 mm,12.14±10.07°,19.16±12.77°,51.35±11.88°,47.65±7.97°,40.86±9.45° and 6.91±7.32°.The mean postoperative Cobb angle last follow-up,C7-CSVL,SVA,CL,TK,LL,PI,SS and PT were respectively 21.33±9.47°,10.41±8.45 mm,19.68±14.33 mm,16.19±7.45°,23.12±7.45°,50.33±11.37°,49.70±9.83°,39.42±8.11° and 10.16±6.63°.The correction rate was acquisition of 66.11%.The preoperative flexibility was 45.77%.There were three groups in reference to the preoperative TK,25 cases of thoracic hypokyphosis group,15 cases of normal kyphosis group and 3 cases of thoracic hyperkyphosis group.Significant differences of TK were attained in both thoracic hypokyphosis group and thoracic hyperkyphosis group(p<0.05).However,comparison of PI and LL before and after operation was not any significant difference respectively in thoracic hyperkyphosis group.There were also not any statistically significant differences in TK,LL and PI between the preoperative and postoperative findings of the normal kyphosis group.Additionally,patients were divided into two groups according to the postoperative TK,including group A with 16 patients and group B with 27 patients.Univariate analysis of the parameters of group A and group B,preoperative TK,preoperative LL and osteotomy were statistically significant(P <0.05),and further multivariate logistic regression analysis,suggested that preoperative LL and Ponte osteotomy were statistically significant(P <0.05).Conclusions: The results of this study demonstrated patients with Lenke1 type AIS achieved satisfactory orthopedic effects after spinal orthopedic surgery,and effectively maintained normal thoracic kyphosis after operation.Preoperative TK,preoperative LL and Ponte osteotomy were related factors for maintaining normal thoracic kyphosis,and preoperative LL and Ponte osteotomy might be independent factors for maintaining normal thoracic kyphosis. |
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