Suk Se-Il, Lee Sang-Min, Chung Ewy-Ryong, Kim Jin-Hyok, Kim Sung-Soo
The Seoul Spine Institute, Inje University Sanggye-Paik Hospital, Seoul, Korea.
Spine (Phila Pa 1976). 2005 Jul 15;30(14):1602-9. doi: 10.1097/01.brs.0000169452.50705.61.
Retrospective study.
To evaluate outcomes of selective thoracic fusion with segmental pedicle screw fixation in thoracic idiopathic scoliosis with a minimum 5-year follow-up.
Segmental pedicle screw fixation has been proven to enable true segmental control and greater correction both in coronal and sagittal planes of scoliosis. However, there is no long-term study of selective thoracic fusion with segmental pedicle screw fixation in thoracic idiopathic scoliosis.
Two hundred and three thoracic idiopathic scoliosis patients with 236 thoracic curves subject to selective thoracic fusion with segmental pedicle screw fixation were analyzed. Mean patient age at the time of operation was 13.8 years (range: 8.9-18).
The preoperative thoracic curve of 51 +/- 12 degrees was corrected to 16 +/- 7 degrees (69% correction, 3% loss of correction) at the most recent follow-up. The noninstrumented lumbar curve of 30 +/- 10 degrees was corrected to 10 +/- 8 degrees (66% correction, 5% loss of correction) at the most recent follow-up. The preoperative thoracic kyphosis of 18 +/- 11 degrees and the lumbar lordosis of 43 +/- 10 degrees were improved to 23 +/- 8 degrees and 46 +/- 9 degrees , respectively, at the most recent follow-up. There was no junctional kyphosis at the most recent follow-up. Coronal decompensation at the most recent follow-up occurred in 10 patients. Postoperative adding-on occurred in 17 patients, who were fused two levels short of the neutral vertebra. Of the 2,867 thoracic pedicle screws inserted in the thoracic level, 43 screws were found to be malpositioned (1.5%), but they did not cause neurologic complications or adversely affect the long-term results.
Selective thoracic fusion with segmental pedicle screw fixation in thoracic idiopathic scoliosis had satisfactory radiographic and clinical outcomes after surgery and has been well-maintained for minimum 5-year follow-up. It is a safe and effective method for preservation of lumbar motion segments as well as for restoration and maintenance of both coronal and sagittal alignment.
回顾性研究。
评估选择性胸椎融合术联合节段性椎弓根螺钉固定治疗特发性胸椎侧弯的疗效，随访至少5年。
节段性椎弓根螺钉固定已被证明能够在脊柱侧弯的冠状面和矢状面实现真正的节段性控制和更大程度的矫正。然而，尚无关于选择性胸椎融合术联合节段性椎弓根螺钉固定治疗特发性胸椎侧弯的长期研究。
分析203例特发性胸椎侧弯患者的236个胸椎弯曲，这些患者接受了选择性胸椎融合术联合节段性椎弓根螺钉固定。手术时患者的平均年龄为13.8岁（范围：8.9 - 18岁）。
在最近一次随访时，术前51±12度的胸椎弯曲矫正至16±7度（矫正率69%，矫正丢失率3%）。术前30±10度的未植入器械的腰椎弯曲在最近一次随访时矫正至10±8度（矫正率66%，矫正丢失率5%）。术前18±11度的胸椎后凸和43±10度的腰椎前凸在最近一次随访时分别改善至23±8度和46±9度。在最近一次随访时未出现交界性后凸。最近一次随访时10例患者出现冠状面失代偿。17例患者术后出现附加融合，融合节段比中立椎短两个节段。在胸椎节段植入的2867枚胸椎椎弓根螺钉中，43枚螺钉位置不当（1.5%），但未引起神经并发症，也未对长期结果产生不利影响。
选择性胸椎融合术联合节段性椎弓根螺钉固定治疗特发性胸椎侧弯术后具有满意的影像学和临床疗效，且在至少5年的随访中疗效良好。这是一种安全有效的方法，可保留腰椎活动节段，并恢复和维持冠状面及矢状面的对线。
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