Watanabe Kei, Lenke Lawrence G, Bridwell Keith H, Kim Yongjung J, Watanabe Kota, Kim Young-Woo, Kim Youngbae B, Hensley Marsha, Stobbs Georgia
Niigata University, Japan.
Spine (Phila Pa 1976). 2008 May 1;33(10):1084-92. doi: 10.1097/BRS.0b013e31816f5f3a.
A retrospective comparative study.
To compare the efficacy and safety of several different anchors in the apical levels of scoliotic curves > or = 100 degrees using radiographic outcomes and clinical complications.
To the best of our knowledge, no reports have compared various anchors at the apical level for correction of scoliosis curves > or = 100 degrees.
Sixty-eight scoliosis patients (44 neuromuscular, 21 idiopathic, and 3 congenital) with major curves > or = 100 degrees (mean, 112.7 degrees; range, 100 degrees -159 degrees ) who underwent segmental spinal instrumentation and fusion with different anchors in the apical level were analyzed. All patients had a minimum 2-year follow-up (mean, 4.0 years; range, 2.0-10.5) and were divided into Group W (sublaminar wires n = 26), Group H (hooks n = 18), Group A (anterior vertebral screws n = 7), and Group PS (pedicle screws n = 17) based on the type of apical anchor used. Radiographic parameters and complications were investigated.
The 4 groups did not demonstrate any significant differences in gender, age at surgery, preoperative major Cobb angle, or curve flexibility (all P > 0.05). However, the PS group demonstrated a shorter follow-up period compared with the other 3 groups (P < 0.05). The PS group demonstrated the greatest correction rate, smallest loss of correction (P < 0.05), and greatest amount of correction of the apical vertebral translation (P < 0.0005) at ultimate follow-up. There were 4 cases (5.9%) of pseudarthrosis (3 in Group W, 1 in Group H; P > 0.05), 6 cases (8.8%) of implant failure (4 in Group W, 2 in Group H; P > 0.05). Despite one (1.5%) intraoperative neurologic complication (differences among groups, P > 0.05), there was no permanent neurologic deficit.
All 4 constructs were able to achieve and maintain acceptable correction safely without permanent neurologic deficit and all demonstrated acceptable implant failure rate. Pedicle screw constructs in the apical levels demonstrated the best coronal correction, smallest loss of correction, and greatest amount of apical vertebral translation correction of the major Cobb angle compared with the other constructs without neurologic complications.
一项回顾性对照研究。
运用影像学结果和临床并发症，比较几种不同的内固定物在顶椎节段治疗Cobb角≥100°的脊柱侧弯的疗效和安全性。
据我们所知，尚无关于比较不同内固定物在顶椎节段治疗Cobb角≥100°的脊柱侧弯的报道。
分析68例脊柱侧弯患者（44例神经肌肉型、21例特发性、3例先天性），其主弯Cobb角≥100°（平均112.7°；范围100°-159°），接受了顶椎节段不同内固定物的节段性脊柱内固定和融合术。所有患者均至少随访2年（平均4.0年；范围2.0 - 10.5年），并根据顶椎内固定物类型分为W组（椎板下钢丝，n = 26）、H组（钩，n = 18）、A组（前路椎体螺钉，n = 7）和PS组（椎弓根螺钉，n = 17）。研究影像学参数和并发症。
4组在性别、手术年龄、术前主Cobb角或侧弯柔韧性方面均无显著差异（所有P > 0.05）。然而，PS组的随访期较其他3组短（P < 0.05）。在末次随访时，PS组的矫正率最高，矫正丢失最小（P < 0.05），顶椎椎体平移矫正量最大（P < 0.0005）。有4例（5.9%）假关节形成（W组3例，H组1例；P > 0.05），6例（8.8%）内固定失败（W组4例，H组2例；P > 0.05）。尽管有1例（1.5%）术中神经并发症（组间差异，P > 0.05），但无永久性神经功能缺损。
所有4种植入物均能安全地实现并维持可接受的矫正效果，无永久性神经功能缺损，且所有内固定失败率均可接受。与其他植入物相比，顶椎节段的椎弓根螺钉植入物在无神经并发症的情况下，在冠状面矫正方面效果最佳，矫正丢失最小，主Cobb角的顶椎椎体平移矫正量最大。
