Lee Stanley S, Lenke Lawrence G, Kuklo Timothy R, Valenté Luis, Bridwell Keith H, Sides Brenda, Blanke Kathy M
Spinal Deformity Service, Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Spine (Phila Pa 1976). 2006 Sep 15;31(20):2316-21. doi: 10.1097/01.brs.0000238977.36165.b8.
Retrospective comparison review.
Compare posterior-only treatment results with segmental thoracic pedicle screw constructs versus combined anterior/posterior fusion in patients with Scheuermann kyphosis.
Traditionally, operative Scheuermann kyphosis has been treated with combined anterior/posterior spinal fusion, with the anterior portion being performed via an open thoracotomy or a video-assisted thoracoscopic approach.
There were 18 patients with Scheuermann kyphosis who underwent a posterior-only thoracic pedicle screw (P/TPS) fusion and 21 who underwent an anterior/posterior fusion who were followed for a 2-year minimum. The 2 groups were well matched according to average age (anterior/posterior fusion 18.0 degrees and P/TPS 17.3 degrees; P = 0.60), maximum preoperative kyphosis (anterior/posterior fusion 89.1 degrees and P/TPS 84.4 degrees; P = 0.21), flexibility index (anterior/posterior fusion 0.408 degrees and P/TPS 0.407 degrees; P > 0.99), and posterior fusion levels (anterior/posterior fusion 12.1 degrees and P/TPS 12.2 degrees; P = 0.95). Of 21 patients with anterior/posterior fusions, zero versus 12 of 18 (67%) patients in the P/TPS group underwent apical Smith-Petersen osteotomies. Fixation in the anterior/posterior fusion group was achieved with hybrid hook/screw constructs. Posterior fixation in the P/TPS group was performed using segmental thoracic pedicle screw constructs. Both groups had posterior iliac bone autografting. Operating time and blood loss were noted, and radiographs were evaluated before surgery, after surgery, and at final follow-up. At final follow up, Scoliosis Research Society-30 questionnaire data and complications were recorded.
At surgery, operating time and blood loss were significantly less in the P/TPS group (P = 0.009 and P = 0.05, respectively). The mean residual kyphosis of the P/TPS group averaged 38.2 degrees after surgery and 40.4 degrees at final follow-up versus anterior/posterior fusion group (51.9 degrees and 58.0 degrees, P < 0.001 and P = 0.001, respectively). Even without an anterior release, kyphosis correction in the P/TPS group averaged 54.2% after surgery and 51.8% at final follow-up versus the anterior/posterior fusion group (41.2% and 38.5%, P = 0.001 and P < 0.001, respectively). Scoliosis Research Society-30 outcome scores at final follow-up were comparable between the 2 groups (P/TPS = 120 and anterior/posterior fusion = 128; P = 0.14). The anterior/posterior fusion group had 8/21 (38%) patients with complications, including paraplegia in 1, proximal junctional kyphosis in 1, proximal hook pullout in 1, and infection in 2. The P/TPS group had no complications (P = 0.003).
With less operating time and intraoperative blood loss, posterior-only Scheuermann kyphosis treatment with thoracic pedicle screws achieved and maintained better correction, and had significantly less complications than with circumferential fusion.
回顾性比较研究。
比较仅采用后路节段性胸椎椎弓根螺钉内固定与前后路联合融合治疗休门氏后凸畸形患者的疗效。
传统上，休门氏后凸畸形的手术治疗采用前后路联合脊柱融合术，前路手术需通过开胸手术或电视辅助胸腔镜手术完成。
18例休门氏后凸畸形患者接受了单纯后路胸椎椎弓根螺钉（P/TPS）融合术，21例患者接受了前后路联合融合术，所有患者均至少随访两年。两组患者在平均年龄（前后路联合融合组18.0岁，P/TPS组17.3岁；P = 0.60）、术前最大后凸角度（前后路联合融合组89.1°，P/TPS组84.4°；P = 0.21）、柔韧性指数（前后路联合融合组0.408°，P/TPS组0.407°；P > 0.99）以及后路融合节段数（前后路联合融合组12.1节，P/TPS组12.2节；P = 0.95）方面匹配良好。在21例接受前后路联合融合术的患者中，0例与P/TPS组18例中的12例（67%）患者进行了顶椎Smith-Petersen截骨术。前后路联合融合组采用钩/螺钉混合内固定。P/TPS组采用节段性胸椎椎弓根螺钉内固定。两组均采用自体髂骨后路植骨。记录手术时间和失血量，并在术前、术后及末次随访时评估X线片。在末次随访时，记录脊柱侧弯研究学会-30问卷数据及并发症情况。
手术时，P/TPS组的手术时间和失血量明显更少（分别为P = 0.009和P = 0.05）。P/TPS组术后平均残留后凸角度为38.2°，末次随访时为40.4°，而前后路联合融合组分别为51.9°和58.0°（分别为P < 0.001和P = 0.001）。即使未进行前路松解术，但P/TPS组术后平均后凸畸形矫正率为54.2%，末次随访时为51.8%，而前后路联合融合组分别为41.2%和38.5%（分别为P = 0.001和P < 0.001）。两组末次随访时的脊柱侧弯研究学会-30结局评分相当（P/TPS组为120分，前后路联合融合组为128分；P = 0.14）。前后路联合融合组有8/21（38%）例患者出现并发症，包括1例截瘫、1例近端交界性后凸、1例近端钩拔出以及2例感染。P/TPS组无并发症发生（P = 0.003）。
采用胸椎椎弓根螺钉单纯后路治疗休门氏后凸畸形，手术时间和术中失血量更少，矫正效果更好且维持良好，并发症明显少于环形融合术。
