Engsberg Jack R, Lenke Lawrence G, Uhrich Mary L, Ross Sandy A, Bridwell Keith H
Human Performance Laboratory, Barnes-Jewish Hospital, St. Louis, MO 63110, USA.
Spine (Phila Pa 1976). 2003 Sep 1;28(17):1993-2000. doi: 10.1097/01.BRS.0000087209.34602.42.
Prospective evaluation of gait and spinal range of motion (ROM) in adolescent idiopathic scoliosis (AIS) patients undergoing either an anterior or a posterior spinal fusion.
Compare changes in gait and spine ROM between AIS patients undergoing either an anterior or posterior spinal fusion.
Problems with AIS posterior spinal fusion and attempts to minimize the number of spinal segments fused have led to the promotion of anterior spinal fusion. Comparison of functional outcomes of the two surgeries has not been reported.
Thirty-one patients with single or double thoracic AIS undergoing an anterior (n = 16) or posterior (n = 15) instrumented spinal fusion underwent gait and triplanar ROM tests before surgery and 24 months postoperative. Videography with reflective surface markers on the scapula, spine, and pelvis were used to quantify changes in gait and trunk ROM.
Surgical results indicated that an average of four fewer levels was fused and the lowest instrumented vertebrae were one level higher in the spine for the anterior group compared to the posterior group. Gait results showed no change in gait speed and no change in coronal and sagittal plane kinematics, regardless of group. Transverse plane motion during gait was reduced in both groups. Spinal ROM results indicated motion loss in all three planes, regardless of group, with the posterior group having less postoperative ROM than the anterior group. Unlinking surgical approach from number of fused levels and lowest instrumented vertebrae with a subset of subjects also indicated less postoperative ROM for the posterior group.
The surgical and ROM results seem to favor the anterior approach over the posterior approach for the classification of patients in this investigation. However, it should be noted that both groups had decreased postoperative ROM.
对接受前路或后路脊柱融合术的青少年特发性脊柱侧凸（AIS）患者的步态和脊柱活动范围（ROM）进行前瞻性评估。
比较接受前路或后路脊柱融合术的AIS患者步态和脊柱ROM的变化。
AIS后路脊柱融合术存在的问题以及尽量减少融合脊柱节段数量的尝试促使了前路脊柱融合术的推广。尚未有关于这两种手术功能结果比较的报道。
31例单胸段或双胸段AIS患者接受了前路（n = 16）或后路（n = 15）器械辅助脊柱融合术，术前及术后24个月进行了步态和三平面ROM测试。使用在肩胛骨、脊柱和骨盆上带有反光表面标记的摄像技术来量化步态和躯干ROM的变化。
手术结果表明，与后路组相比，前路组平均融合节段少4个，脊柱内最低固定椎体高1个节段。步态结果显示，无论哪一组，步态速度均无变化，冠状面和矢状面运动学也无变化。两组在步态期间的横断面运动均减少。脊柱ROM结果表明，无论哪一组，所有三个平面的运动均有损失，后路组术后ROM比前路组少。对部分受试者将手术方式与融合节段数量及最低固定椎体脱钩分析也表明后路组术后ROM较少。
在本研究中，对于此类患者的分类，手术和ROM结果似乎表明前路手术优于后路手术。然而，应注意的是，两组术后ROM均有所下降。
