2012年作为第一作者发表于SPINE杂志的学术论文， 该文对双弯型青少年特发性脊柱侧弯患者术后出现躯干失平衡的原因进行了系统的分析并讨论了预防措施。
北京大学第一医院骨科王宇
论文信息：
Wang Y (corresponding author), Bünger CE, Wu C, et al. Postoperative Trunk Shift in Lenke 1C Scoliosis: What causes it? How can it be prevented? (Epub ahead of print, Spine)
论文摘要：
Study Design. A risk-factor-analysis study.
Objective. To identify causative factors for postoperative trunk shift in Lenke 1C scoliosis and investigate how to prevent it.
Summary of Background Data. When selective thoracic fusion is performed, postoperative trunk shift is a significant problem in the management of Lenke 1C scoliosis. It is often accompanied by unsatisfactory clinical outcomes and a risk of reoperation.
Methods. We reviewed all the AIS cases surgically treated in our institution from 2002 through 2008. Inclusion criteria were as follows: (1) patients with Lenke 1C curves who were treated with selective thoracic fusion using posterior pedicle screw-only constructs; (2) the LIV ending at L1 level or above; (3) 2-year radiographic follow-up. Eighteen radiographic parameters were chosen as potential risk factors. The eighteen parameters measured: (I) amount of correction obtained by surgery; (II) pre-op position of LIV; (III) magnitude of MT and TL/L curves and ratio of MT: TL/L curve; (IV) curve flexibility. Both comparative and correlation analyses were performed. Those parameters which had shown highest correlation with the 2-year thoracic AV-CSVL distance were selected to form a linear regression model, by which the correlations were quantified.
Results. Of the 278 patients reviewed, 44 met the inclusion criteria. The parameters which measured the pre-op position of LIV and ratio of MT: TL/L curve showed high correlation with the 2-year thoracic AV-CSVL distance. With regard to the parameters which measured the amount of correction obtained by surgery, only the correction of the thoracic AV-T1 distance showed low correlation. Among the eighteen parameters, pre-op LIV-LEV difference and ratio of MT: TL/L Cobb angle were selected to form a formula to help predict postoperative trunk shift. The formula was: 2-year thoracic AV-CSVL distance = -26.6 + 22.7(ratio of MT: TL/L Cobb angle) C 3.9(Pre-op LIV-LEV difference). The model R2=0.55.
Conclusion. Both LIV selection and ratio of MT: TL/L curve were found to be highly correlated with the onset of postoperative trunk shift in Lenke 1C scoliosis. Amount of correction obtained by surgery, however, did not seem to be an independent causative factor. Postoperative trunk shift is less likely to occur when selecting LEV as LIV and the ratio of MT: TL/L Cobb angle ≥ 1.2.
论文图示：