成人腰椎畸形融合至L5或S1时近端融合至那一椎体更可靠是T9 T11 还是 L1 课件.pptVIP

From SpineIs the T9, T11, or L1 the More Reliable Proximal Level After Adult Lumbar or Lumbosacral Instrumented Fusion to L5 or S1? 成人腰椎畸形融合至L5或S1时，近端融合至那一椎体更可靠，是T9, T11, 还是 L1 ？ Author Yongjung J. Kim, MD; Keith H. Bridwell, MD; Lawrence G. Lenke, MD; Seungchul Rhim, MD; Young-Woo Kim, MD Abstract Summary of Background Data: Few comparative studies on postoperative sagittal plane change and revision prevalence as influenced by 3 different proximal levels after adult lumbar deformity instrumented fusion from the distal thoracic/upper lumbar spine (T9–L2) to L5 or S1 have been published. Many surgeons have hypothesized that stopping proximally in the upper lumbar spine (L1 or L2) or the thoracolumbar junction (T11 or T12) would lead to a high percentage of rapid proximal degeneration, kyphosis, and decompensation because of the concentration of stress on these relatively mobile segments. Therein, many surgeons have felt it is unsafe to stop at these regions of the spine and it is better to always stop proximally at T9 or T10. 背景资料 成人腰椎畸形从下胸椎或者上腰椎融合至腰5或骶1，对矢状面的影响如何及翻修率怎样，很少有此方面的对比研究发表 。许多医生推测如果融合至上腰椎（腰1、2）或者胸腰交界处（胸11、12），由于该处应力的集中，会导致近端间盘快速的退变，产生后凸畸形 。因此他们认为融合到胸11以下是不安全的，而更愿意融合到胸9和胸10. Study Design: A retrospective comparison study. 回顾性对比研究 Objective: To compare the postoperative proximal junctional change and revision prevalence as influenced by 3 different proximal levels after adult lumbar deformity instrumented fusion from the distal thoracic/upper lumbar spine (T9–L2) to L5 or S1. 目的：比较3种不同的近端融合椎对融合至L5 or S1 的成人腰椎畸形患者近端交界区的影响及翻修的发生率。 Methods: A clinical and radiographic assessment in addition to revision prevalence of 125 adult lumbar deformity patients (average age 57.1 year) who underwent long (average 7.1 vertebrae) segmental posterior spinal instrumented fusion from the distal thoracic/upper lumbar spine (T9–L2) to L5 or S1 with a minimum 2-year follow-up (2–19.8 year follow-up) were compared as influenced by T9–T10 (group1, n = 37), T11–T12 (group