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中国脊柱侧凸年会AIS远端固定椎的选择和Adding - 如何避免术后失代偿？
　　如何在实现良好的脊柱矫形和躯干平衡的同时尽量减少融合节段，是脊柱外科医师追求的目标。随着矫形技术的不断发展，青少年特发性脊柱侧凸（adolescent idiopathic scoliosis, AIS）的手术疗效不断提高，但是术后失代偿的发生仍然是不可忽视的临床问题。冠状面失代偿多因远端固定椎（lowest instrumented vertebra, LIV）的选择不当或过度矫正有关。当LIV选择过短会导致叠加现象（adding-onphenomenon），远端叠加现象的发生率在8%~51%之间[1, 2]。引起AIS三维矫形术后冠状面失代偿的危险因素很多，融合方式，内固定方式，生长潜能等均与术后失代偿发生有关[3]。而引起远端叠加现象最大的危险因素就是LIV选择不当，适当的LIV可以有效预防远端Adding on现象[4]。通常，LIV多选择稳定椎、下端椎或下端椎上方1~2个椎体[5]，有学者认为LIV与骶骨正中垂线（CSVL）的距离也应在考虑在内[6]，然而对于这些参数的界定和选择上仍然存在争论。您认为如何选择远端固定椎？如何维持术后平衡，避免术后失代偿及Adding-on现象呢？
References:
[1]. Suk,S.I., et al., Determination of distal fusion level with segmental pedicle screwfixation in single thoracic idiopathic scoliosis. Spine (Phila Pa 1976), 2003.28(5): p. 484-91.
[2]. Matsumoto,M., et al., Postoperative distal adding-on and related factors in Lenke type 1Acurve. Spine (Phila Pa 1976), 2013. 38(9): p. 737-44.
[3]. Cho,R.H., et al., Which Lenke 1A curves are at the greatest risk for adding-on...and why? Spine (Phila Pa 1976), 2012. 37(16): p. 1384-90.
[4]. Wang,Y., et al., Distal adding-on phenomenon in Lenke 1A scoliosis: risk factoridentification and treatment strategy comparison. Spine (Phila Pa 1976), 2011.36(14): p. 1113-22.
[5]. Erickson,M.A. and D.M. Baulesh, Lowest instrumented vertebra selection in AIS. J PediatrOrthop, 2011. 31(1 Suppl): p. S69-76.
[6]. Wang,Y., et al., Distal adding-on in Lenke 1A scoliosis: how to more effectivelydetermine the onset of distal adding-on. Spine (Phila Pa 1976), 2013. 38(6): p.490-5.