Rhee John M, Bridwell Keith H, Won Douglas S, Lenke Lawrence G, Chotigavanichaya Chatupon, Hanson Darrell S
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Spine (Phila Pa 1976). 2002 Nov 1;27(21):2350-6. doi: 10.1097/00007632-200211010-00008.
Radiographic analysis of anterior and posterior instrumentation for adolescent idiopathic scoliosis.
To compare effects of anterior versus posterior instrumentation on sagittal plane parameters.
The sagittal plane is critical to the long-term success of scoliosis surgery, but few studies have compared the effect of anterior versus posterior instrumentation.
Standing, full spine lateral radiographs of 110 consecutive patients (mean age 14 years) who had surgery for adolescent idiopathic scoliosis between 1996 and 1998 at one institution with a minimum 24-month (mean 32 months) follow-up were evaluated. Fifty patients were instrumented anteriorly with single screw-rod constructs. Sixty patients were instrumented posteriorly with segmental implants (5.5 mm; hooks, wires, and/or pedicle screws).
At the final follow-up, the proximal junctional measurement (measured between the proximal instrumented vertebra and the segment two levels cephalad) increased most with posterior instrumentation (+7 degrees increase for posterior thoracic +1 degrees increase for anterior thoracic instrumentation, P= 0.02; +9 degrees increase for posterior thoracic and lumbar instrumentation vs. +4 degrees for anterior thoracolumbar instrumentation, P= 0.03). Thoracic kyphosis (T5-T12) increased significantly with anterior versus posterior thoracic instrumentation (+4 degrees vs. -2 degrees change, P= 0.04). Lumbar lordosis (T12-S1) was enhanced with either anterior or posterior instrumentation. No significant changes in distal junctional measurement (measured between the distal instrumented vertebra and the segment two levels caudal) were noted. The C7 sagittal plumbline remained negative in all groups at the final follow-up.
Anterior and posterior instrumentation had differential effects on the sagittal plane in patients with adolescent idiopathic scoliosis. However, the overall magnitude of the differences was small. Properly performed, both approaches can result in acceptable sagittal profiles.
青少年特发性脊柱侧凸前路与后路内固定的影像学分析。
比较前路与后路内固定对矢状面参数的影响。
矢状面对脊柱侧凸手术的长期成功至关重要，但很少有研究比较前路与后路内固定的效果。
对1996年至1998年在一家机构接受青少年特发性脊柱侧凸手术的110例连续患者（平均年龄14岁）进行站立位全脊柱侧位X线片评估，随访至少24个月（平均32个月）。50例患者采用单螺杆结构进行前路内固定。60例患者采用节段性植入物（5.5毫米；钩、钢丝和/或椎弓根螺钉）进行后路内固定。
在末次随访时，近端交界区测量值（在近端固定椎体与头侧两个节段之间测量）在后路内固定时增加最多（后路胸段增加7度，前路胸段增加1度，P = 0.02；后路胸腰段增加9度，前路胸腰段增加4度，P = 0.03）。前路与后路胸段内固定相比，胸段后凸（T5-T12）显著增加（变化分别为+4度和-2度，P = 0.04）。前路或后路内固定均可增强腰段前凸（T12-S1）。远端交界区测量值（在远端固定椎体与尾侧两个节段之间测量）无显著变化。在末次随访时，所有组的C7矢状垂直线均为阴性。
前路和后路内固定对青少年特发性脊柱侧凸患者的矢状面有不同影响。然而，差异的总体幅度较小。如果操作得当，两种方法都能产生可接受的矢状面轮廓。
