Kim Yongjung J, Lenke Lawrence G, Kim Junghoon, Bridwell Keith H, Cho Samuel K, Cheh Gene, Sides Brenda
Department of Orthopaedic Surgery, Washington University School of Medicine, and Shriners Hospitals for Children, St. Louis, MO, USA.
Spine (Phila Pa 1976). 2006 Feb 1;31(3):291-8. doi: 10.1097/01.brs.0000197865.20803.d4.
A retrospective matched cohort study.
To comprehensively compare the 2-year postoperative results of posterior correction and fusion with segmental pedicle screw instrumentation versus with hybrid (proximal hooks and distal pedicle screws) constructs in adolescent idiopathic scoliosis (AIS) treated at a single institution.
Despite the reports of satisfactory correction and maintenance of scoliotic curves by pedicle screw instrumentation, there have been no reports on the comprehensive comparison of AIS treatment after segmental pedicle screw instrumentation versus hybrid instrumentation.
A total of 58 AIS patients that underwent posterior fusion with hybrid instrumentation (29) or pedicle screw (29) instrumentation at a single institution were sorted and matched according to four criteria: similar patient age, fusion levels, identical Lenke curve type, and identical operative methods. Patients were compared at 2-year follow-up according to radiographic changes, operative time, intraoperative blood loss, pulmonary function tests, and SRS-24 outcome scores.
The two cohorts were well matched. The preoperative major Cobb angle averaged 62 degrees in the screw group and 60 degrees in the hybrid group. Average major curve correction was 70% in the screw group and 56% in the hybrid group (P = 0.001). At 2-year follow-up, major curve correction was 65% and 46%, respectively (P < 0.001). At 2-year follow-up, thoracic sagittal Cobb angle changes between T5 and T12 were 9.0 degrees decrease in the screw group and 2.4 degrees decrease in the hybrid group compared with preoperative (P = 0.024). There were no differences in the lowest instrumented vertebra below the lower end vertebra (P = 0.56), operative time (P = 0.14), and average estimated blood loss (P = 0.54). Two years following surgery, the screw group demonstrated improved percent predicted pulmonary function values compared with that of the hybrid group (FVC; 81% --> 81% in screw group vs. 85% --> 79% in hybrid group P = 0.08, FEV1; 73% --> 79% in screw group vs. 79% --> 75% in hybrid group, P = 0.006). Postoperative total SRS-24 scores were similar in both groups (hybrid group: 99 vs. screw group: 95) (P = 0.19). There were no neurologic complications related to hybrid or pedicle screw instrumentation.
Pedicle screw instrumentation offers a significantly better major curve correction and postoperative pulmonary function values without neurologic problems compared with hybrid constructs. Both instrumentation methods offer similar junctional change, lowest instrumented vertebra, operative time, and postoperative SRS-24 outcome scores in the operative treatment of AIS.
一项回顾性配对队列研究。
全面比较在单一机构接受治疗的青少年特发性脊柱侧凸（AIS）患者中，采用节段性椎弓根螺钉内固定与混合（近端钩和远端椎弓根螺钉）结构进行后路矫正和融合术后2年的结果。
尽管有报道称椎弓根螺钉内固定对脊柱侧凸曲线的矫正和维持效果令人满意，但尚无关于节段性椎弓根螺钉内固定与混合内固定治疗AIS的全面比较的报道。
共有58例在单一机构接受后路融合的AIS患者，其中采用混合内固定（29例）或椎弓根螺钉内固定（29例），根据四个标准进行分类和配对：相似的患者年龄、融合节段、相同的Lenke曲线类型和相同的手术方法。在2年随访时，根据影像学变化、手术时间、术中失血、肺功能测试和SRS - 24结局评分对患者进行比较。
两组队列匹配良好。螺钉组术前主要Cobb角平均为62度，混合组为60度。螺钉组平均主弯矫正率为70%，混合组为56%（P = 0.001）。在2年随访时，主弯矫正率分别为65%和46%（P < 0.001）。在2年随访时，与术前相比，螺钉组T5至T12之间的胸段矢状面Cobb角变化为减少9.0度，混合组为减少2.4度（P = 0.024）。最低固定椎以下的最低固定椎体（P = 0.56）、手术时间（P = 0.14）和平均估计失血量（P = 0.54）无差异。术后2年，螺钉组预测肺功能值百分比相比混合组有所改善（用力肺活量；螺钉组81% --> 81%，混合组85% --> 79%，P = 0.08，第1秒用力呼气量；螺钉组73% --> 79%，混合组79% --> 75%，P = 0.006）。两组术后SRS - 24总分相似（混合组：99分，螺钉组：95分）（P = 0.19）。没有与混合或椎弓根螺钉内固定相关的神经并发症。
与混合结构相比，椎弓根螺钉内固定在主要曲线矫正和术后肺功能值方面明显更好，且无神经问题。在AIS的手术治疗中，两种内固定方法在交界区变化、最低固定椎体、手术时间和术后SRS - 24结局评分方面相似。
