Suk Se-Il, Kim Jin-Hyok, Kim Sung-Soo, Lee Jeong-Joon, Han Yong-Tak
Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea.
Spine (Phila Pa 1976). 2008 May 1;33(10):1061-7. doi: 10.1097/BRS.0b013e31816f2888.
Retrospective study.
To evaluate the effect and outcome of thoracoplasty in conjunction with pedicle screw instrumentation in the treatment of thoracic adolescent idiopathic scoliosis (AIS).
Some spine surgeons recently think more correction of hump deformity using pedicle screws without thoracoplasty. Although thoracoplasty has been conventional treatment of rib hump, there are few papers about the results of pedicle screw instrumentation and concomitant thoracoplasty.
Eighty-seven patients with thoracic AIS (mean age, 14.4 years) treated by pedicle screw instrumentation were retrospectively analyzed after a minimum follow-up of 2 years. Patients were divided into 3 groups; N-T group (no thoracoplasty with iliac bone graft, n = 37), T+N-DVR [thoracoplasty without direct vertebral rotation (DVR), n = 20] and T+DVR group (thoracoplasty with DVR, n = 30). In the T (T+N-DVR and T+DVR) group, 4 to 8 ribs were resected and used for bone graft. Patients were evaluated for deformity correction, balance, pulmonary function, height and angle of rib hump, clinical outcomes (SRS-30), and complications.
In the N-T group, the thoracic curve was corrected from 53 degrees to 16 degrees (69% correction), in the T+N-DVR group from 55 degrees to 18 degrees (69%) and in the T+DVR group from 54 degrees to 10 degrees (81%). There was no difference in postoperative spinal balance and pulmonary function among the 3 groups. The correction rates of hump height and angle were 35% and 38% in the N-T group, respectively, 57% and 58% in the T+N-DVR, and 70% and 72% in the T+DVR. The T group showed significantly better correction of rib hump and self-image score in the SRS-30 questionnaire than the N-T group. There were 8 iliac donor site problems in the N-T group and 3 hemothorax in the T group, which had no adverse effect in the final result.
Thoracoplasty showed significantly better rib hump correction, satisfactory clinical outcomes without pulmonary function compromise, or iliac bone graft site morbidity in the treatment of thoracic AIS with pedicle screw instrumentation.
回顾性研究。
评估胸廓成形术联合椎弓根螺钉内固定治疗青少年特发性脊柱侧凸（AIS）的效果及结果。
一些脊柱外科医生最近认为，使用椎弓根螺钉而不进行胸廓成形术能更好地矫正驼峰畸形。尽管胸廓成形术一直是治疗肋骨驼峰的传统方法，但关于椎弓根螺钉内固定联合胸廓成形术结果的文献较少。
对87例接受椎弓根螺钉内固定治疗的胸椎AIS患者（平均年龄14.4岁）进行回顾性分析，随访至少2年。患者分为3组；N-T组（未行胸廓成形术，行髂骨植骨，n = 37），T+N-DVR组[胸廓成形术但无直接椎体旋转（DVR），n = 20]和T+DVR组（胸廓成形术联合DVR，n = 30）。在T组（T+N-DVR组和T+DVR组），切除4至8根肋骨用于植骨。对患者进行畸形矫正、平衡、肺功能、身高、肋骨驼峰角度、临床结果（SRS-30）及并发症评估。
N-T组胸椎侧弯从53度矫正至16度（矫正率69%），T+N-DVR组从55度矫正至18度（矫正率69%），T+DVR组从54度矫正至10度（矫正率81%）。3组术后脊柱平衡和肺功能无差异。N-T组驼峰高度和角度矫正率分别为35%和38%，T+N-DVR组为57%和58%，T+DVR组为70%和72%。T组在SRS-30问卷中肋骨驼峰矫正及自我形象评分明显优于N-T组。N-T组有8例髂骨供区问题，T组有3例血胸，对最终结果无不良影响。
在使用椎弓根螺钉内固定治疗胸椎AIS时，胸廓成形术在矫正肋骨驼峰方面效果显著更好，临床结果满意，未损害肺功能，也未出现髂骨植骨部位并发症。
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