Sweet F A, Lenke L G, Bridwell K H, Blanke K M, Whorton J
Department of Orthopedic Surgery, Washington School of Medicine, St. Louis, Missouri, USA.
Spine (Phila Pa 1976). 2001 Sep 15;26(18):1956-65. doi: 10.1097/00007632-200109150-00005.
Prospective clinical cases series.
To prospectively evaluate outcomes and critically review radiographic results and complications associated with single solid rod anterior spinal fusions in adolescent idiopathic scoliosis with 2-year minimum follow-up (range, 2-6 years).
Ninety consecutive patients at a single institution with thoracic (n = 43) or thoracolumbar/lumbar (n = 47) adolescent idiopathic scoliosis were treated by one of two surgeons with a similar anterior surgical technique using rib autograft, intradiscal structural (Harms) cages placed below T12, and anterior single solid rod convex compressive instrumentation. The patients were evaluated prospectively with the Scoliosis Research Society outcome instrument and upright radiographs before surgery and minimum 2-year follow-up. RESULTS (RADIOGRAPHIC): The average coronal correction of thoracic curves was from 55 degrees to 29 degrees (47%). The average correction of thoracolumbar/lumbar curves was from 50 degrees to 15 degrees (70%). In the sagittal plane, kyphosis was improved in thoracic fusions from 23 degrees to 30 degrees (T5-T12) and lordosis maintained in thoracolumbar/lumbar fusions at -58 degrees (T12-sacrum). Five patients (5.5%) developed a pseudarthrosis, four with implant failure. Three of five required a posterior fusion for a reoperation rate of 3.3%. The fourth and fifth patients were asymptomatic and appeared fused at the 2-year follow-up, with minimal loss of correction. Common risk factors for pseudarthrosis were smoking (4 of 5), weight >70 kg (4 of 5), and for thoracic pseudarthrosis, hyperkyphosis >40 degrees T5-T12 (2 of 3). RESULTS (CLINICAL OUTCOME): Scoliosis Research Society domain average scores were improved for function, pain, and self-image (P < 0.01). With the Scoliosis Research Society satisfaction domain, 88% responded that they were satisfied with their results and 89% would undergo the same treatment again. Four of five patients with pseudarthrosis did not have statistically significant lower final Scoliosis Research Society scores than those with solid fusions (93 vs. 97, P = 0.18).
Anterior instrumented fusions for adolescent idiopathic scoliosis using a single solid rod had good radiographic and clinical outcomes. Consideration should be given to alternate techniques in larger adolescents (>70 kg) with thoracic hyperkyphosis (>40 degrees ), and smoking should be avoided. Poor radiographic outcomes did not correlate with final Scoliosis Research Society scores.
前瞻性临床病例系列。
前瞻性评估青少年特发性脊柱侧凸单根实心棒前路脊柱融合术的疗效，并严格审查其影像学结果及并发症，随访时间至少2年（范围2至6年）。
在单一机构中，90例连续的青少年特发性脊柱侧凸患者，其中胸椎侧凸（n = 43）或胸腰段/腰段侧凸（n = 47），由两位手术技术相似的外科医生之一采用自体肋骨移植、在T12以下置入椎间盘内结构性（哈姆斯）椎间融合器以及前路单根实心棒凸侧加压内固定术进行治疗。术前及至少2年随访时，采用脊柱侧凸研究学会的疗效评估工具及站立位X线片对患者进行前瞻性评估。结果（影像学）：胸椎侧凸的平均冠状面矫正角度从55度降至29度（矫正率47%）。胸腰段/腰段侧凸的平均矫正角度从50度降至15度（矫正率70%）。矢状面方面，胸椎融合术后后凸畸形从23度改善至30度（T5 - T12），胸腰段/腰段融合术后腰椎前凸维持在 - 58度（T12 - 骶骨）。5例患者（5.5%）出现假关节形成，其中4例伴有内植物失败。5例中有3例需要二期后路融合手术，再次手术率为3.3%。第4例和第5例患者无症状，在2年随访时显示融合良好，矫正丢失极少。假关节形成的常见危险因素为吸烟（5例中有4例）、体重>70 kg（5例中有4例），对于胸椎假关节形成，T5 - T12节段后凸畸形>40度（3例中有2例）。结果（临床疗效）：脊柱侧凸研究学会各领域的平均得分在功能、疼痛和自我形象方面均有改善（P < 0.01）。在脊柱侧凸研究学会满意度方面，88%的患者表示对结果满意，89%的患者愿意再次接受相同治疗。5例假关节形成患者中有4例最终的脊柱侧凸研究学会得分与融合良好患者相比，差异无统计学意义（93分对97分，P = 0.18）。
青少年特发性脊柱侧凸采用单根实心棒前路内固定融合术具有良好的影像学和临床疗效。对于体型较大（>70 kg）且胸椎后凸畸形较大（>40度）的青少年患者，应考虑采用其他技术，同时应避免吸烟。影像学结果不佳与最终的脊柱侧凸研究学会得分无关。
