Objective To demonstrate the behavior of spontaneous correction of the proximal tho-racic curve after selective anterior correction in idiopathic scoliosis and analyze its predictors. Methods A total of 29 females with Lenke type 5 idiopathic scoliosis, with an average age of 15.3±2.0 years (range, 12-20) and an average Hisser grade of 3.8±0.8 (range, 0-5), were included. They were treated with anterior se-lective correction, and followed up 24 to 58 months. Results The primary curves were corrected from 47.6°±6.2° preoperatively to 11.9°±7.3° at the final follow-up. The uninstrumented proximal thoracic curves spon-taneously changed from 27.4°±6.7° preoperatively to 16.7°±7.5° at the final follow-up. The correction on pre-operative side-bending X-ray was found to be lower in patients who had more than 2° proximal curve correc-tion loss (F=5.408, P=0.028). There were 3 patients with marked correction loss of proximal curve, among whom two had a preoperative Cobb angle larger than 35°, two bad a flexibility less than 50% and one had a Hisser sign of Grade 0. Correlation analyses revealed that the magnitude of the proximal curve at final follow-up was correlated positively with the preoperative proximal curve magnitude (r=0.664, P< 0.001), the preop-erative side-bending Cobb angle of proximal curve (r=0.555, P=0.001), and the ratio of the proximal curve to the primary curve before surgery (r=0.515, P=-0.002). And the correction rate of the proximal curve was cor-related positively with the correction rate on preoperative side-bending film (r=0.495, P=0.006). Conclusion Growth potential, the curve magnitudes and curve flexibility of proximal thoracic curves before surgery might influence the spontaneous correction of proximal thoracic curves after anterior selective fusion for Lenke type 5 scoliosis, whereas the extent of the spontaneous correction could not be fully predicted according to the curve flexibility.%目的 探讨Lenke 5型脊柱侧凸前路选择性融合术后胸弯的转归及其可能的影响因素.方法 回顾性分析伴有胸弯的29例女性Lenke 5型脊柱侧凸患者,年龄12～20岁,平均(15.3±2.0)岁;Risser征0～5级,平均(3.8±0.8)级.所有患者均行前路选择性融合术,随访24～58个月,平均33个月,分析术后胸弯的转归及其与术前相关指标的关系.结果所有患者行前路选择性融合术后,主弯Cobb角减小至11.9°±7.3°(矫正率为74.7%±15.3%),胸弯Cobb角减小至16.7°±7.5°(矫正率为40.4%±21.8%).胸弯Cobb角矫正丢失2°以上的9例患者术前胸弯Bending相矫正率较低(F=5.408,P=0.028).在发生显著胸弯矫正丢失的3例患者中,2例术前胸弯Cobb角均达35°以上,2例胸弯柔软度低于50%,1例主弯和胸弯Cobb角比值低于1.25,1例Risser征为0级.末次随访时,胸弯Cobb角与术前胸弯Cobb角、胸弯Bending相Cobb角以及胸弯和主弯Cobb角比值均正相关(分别为r=0.664,19<0.001;r=0.555,P=0.001;r=0.515,P=0.002).而末次随访时胸弯矫正率则与术前胸弯Bending相矫正率正相关(r=0.495,P=0.006).结论 Lenke 5型患者行前路选择性融合术后胸弯的自发性矫正可能与术前胸弯Cobb角、柔软度以及生长潜能等密切相关,但术前胸弯柔软度小能完全反映术后自发性矫正的程度.
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