Westerlund L E, Gill S S, Jarosz T S, Abel M F, Blanco J S
Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Spine (Phila Pa 1976). 2001 Sep 15;26(18):1984-9. doi: 10.1097/00007632-200109150-00008.
A retrospective study to determine the efficacy of posterior-only unit rod instrumentation and fusion in a skeletally immature neuromuscular scoliosis population.
To determine whether the posterior-only approach to this population adequately addresses the concerns of correction of scoliosis and pelvic obliquity, maintenance of that correction over time, and the incidence of crankshaft phenomenon.
Controversy exists regarding the need for anterior release to improve curve flexibility and the need to obtain an anterior arthrodesis in those skeletally immature patients at risk for crankshafting with continued anterior growth.
From 1992 through 1997, 28 consecutive skeletally immature patients with neuromuscular scoliosis underwent posterior-only unit rod instrumentation and fusion for the treatment of progressive, symptomatic spinal deformities. Preoperative, immediate postoperative, and final follow-up radiographs were analyzed with respect to scoliosis and pelvic obliquity correction, maintenance of that correction over time, and the development of the crankshaft phenomenon as evidenced by loss of correction and/or increased rib-vertebral angle difference. The average age of the patients was 12.8 years and the average follow-up was 58 months with a minimum of 2 years.
Twenty-six patients were available for final follow-up. The initial Cobb angle correction averaged 66%, with 75% of the pelvic obliquity corrected. These corrections were maintained over time. Before surgery 27 of 28 patients were Risser 0, 1, or 2. The triradiate cartilage was open in nine patients, and five patients were < or =10 years of age. At the final follow-up 22 of the 26 patients were Risser 5 and 4 were Risser 4. There was one patient with increased rib-vertebral angle difference over the length of follow-up, with no loss of frontal or sagittal plane alignment.
These results indicate that even in the very young neuromuscular patient, acceptable amounts of curve correction can be achieved and maintained with posterior-only unit rod instrumentation and fusion. The biomechanical stiffness of this construct seemed to be able to prevent the crankshaft phenomenon in the majority of those patients at risk.
一项回顾性研究，以确定仅后路单棒器械固定及融合术在骨骼未成熟的神经肌肉型脊柱侧凸患者中的疗效。
确定针对该人群的单纯后路手术方法能否充分解决脊柱侧凸和骨盆倾斜的矫正问题、随着时间推移维持矫正效果以及曲轴现象的发生率。
对于骨骼未成熟且有因前方持续生长而发生曲轴现象风险的患者，是否需要前路松解以提高曲线柔韧性以及是否需要进行前路融合术存在争议。
1992年至1997年，28例连续的骨骼未成熟神经肌肉型脊柱侧凸患者接受了仅后路单棒器械固定及融合术，以治疗进行性、有症状的脊柱畸形。分析术前、术后即刻及末次随访的X线片，观察脊柱侧凸和骨盆倾斜的矫正情况、随着时间推移矫正效果的维持情况以及曲轴现象的发生情况，曲轴现象表现为矫正丢失和/或肋椎角差异增加。患者的平均年龄为12.8岁，平均随访时间为58个月，最短随访2年。
26例患者可供进行末次随访。初始Cobb角矫正平均为66%，75%的骨盆倾斜得到矫正。这些矫正效果随时间得以维持。术前28例患者中有27例Risser分级为0、1或2级。9例患者的三骨骺软骨开放，5例患者年龄≤10岁。末次随访时，26例患者中有22例Risser分级为5级，4例为4级。在随访期间有1例患者的肋椎角差异增加，但矢状面和冠状面的对线未丢失。
这些结果表明，即使是非常年轻的神经肌肉型患者，仅后路单棒器械固定及融合术也能实现并维持可接受程度的曲线矫正。该结构的生物力学刚度似乎能够在大多数有风险的患者中预防曲轴现象。
