Bullmann V, Liljenqvist U R, Schmidt C, Schulte T L
Sektion Wirbelsäulenorthopädie, Klinik und Poliklinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum, Münster, Deutschland.
Orthopade. 2009 Feb;38(2):198-200, 202-4. doi: 10.1007/s00132-008-1370-x.
Posterior correction and fusion of scoliosis with multisegmental instrumentation systems was developed by Cotrel-Dubousset in the 1980s. Initially correction and instrumentation was performed using hooks only. Later pedicle screws were implemented first for the lumbar and then for the thoracic spine. Nowadays instrumentation based on pedicle screws only is well established for posterior scoliosis surgery. Biomechanical studies demonstrated higher pull-out forces for pedicle than for hook constructs.In clinical studies several authors reported better Cobb angle correction of the primary and the secondary curves and less loss of correction in pedicle screw versus hook instrumentations. Furthermore, pedicle screw instrumentation allows fewer segments to be fused, especially caudally, and thus saving mobile segments. In most of these publications there were no differences in operation time, blood loss and complication rates. In summary, there is better curve correction without an increased risk using multisegmental pedicle screw instrumentation in modern posterior scoliosis surgery.
20世纪80年代，Cotrel-Dubousset研发了多节段器械系统用于脊柱侧弯的后路矫正与融合。最初，矫正和器械固定仅使用钩。后来，椎弓根螺钉首先应用于腰椎，随后应用于胸椎。如今，仅基于椎弓根螺钉的器械固定在脊柱侧弯后路手术中已得到广泛应用。生物力学研究表明，椎弓根结构的拔出力高于钩结构。在临床研究中，多位作者报告称，与钩器械固定相比，椎弓根螺钉在主弯和次弯的Cobb角矫正方面效果更好，矫正丢失更少。此外，椎弓根螺钉器械固定允许融合的节段更少，尤其是在尾端，从而保留了活动节段。在大多数这些出版物中，手术时间、失血量和并发症发生率没有差异。总之，在现代脊柱侧弯后路手术中，使用多节段椎弓根螺钉器械固定可实现更好的弯度矫正，且风险不会增加。
