McGill Scoliosis and Spine Centre, McGill University Health Centre, Shriners Hospital, Montreal, Canada.
Spine (Phila Pa 1976). 2009 Nov 15;34(24):2679-85. doi: 10.1097/BRS.0b013e3181bf8ee3.
A retrospective analysis of prospectively collected data on a cohort of 19 myelomeningocele patients undergoing spino-pelvic deformity surgery.
To examine if greater curve correction with third generation spinal implants correlate with improved pressure distribution and resolution, or prevention of skin ulcerations in myelomeningocele patients.
Children born with myelomeningocele have often complex spino-pelvic deformities leading to skin ulcerations.
A cohort of 19 consecutive wheelchair dependent patients with myelodisplastic spinal deformities, who underwent spinal surgery, was prospectively followed with regular pressure mappings for a minimum of 2 years. Standard spino-pelvic radiologic measurements were obtained. Sitting pressure mappings were obtained over the study period using the Force Sensitive Applications from Vista Medical (Winnipeg, Manitoba, Canada). Statistical analysis was done using SAS (SAS Institute Inc, Cary, NC). Paired t-test and Wilcox on Signed Rank test was used where applicable. Significance was taken to be P<0.05.
Surgery significantly corrected radiographic parameters, specifically, Cobb angle (52%), pelvic obliquity (89%), and to a lesser degree pelvic tilt. Stratifying the data based on fixation type showed that the M-W construct was able to significantly correct pelvic obliquity. While significant changes in radiographic variables were observed after surgery, this was not the case with the various pressure mapping variables. Only minor changes after surgery were observed in the average pressure, maximum pressure, and variable coefficient of pressure. What was observed was an improvement in the overall distribution from anterior/posterior and right/left. While the values only approached statistical significance (P=0.053) for right/left, however, this did not appear to be clinically significant regarding skin ulceration.
Despite significant surgical corrections in radiographic parameters, these resulted in small changes in pressure distributions and do not appear to influence skin ulceration in the myelomeningocele patient. Pressure mapping may not be a useful tool in predicting outcome of spinal surgery. Factors which were proven to influence pressure distribution are the sagittal pelvic orientation and also achieving coronal spine balance.
对 19 例接受脊柱骨盆畸形手术的脊髓脊膜膨出患者前瞻性收集数据的回顾性分析。
检查第三代脊柱植入物的更大曲线矫正是否与改善压力分布和缓解或预防脊髓脊膜膨出患者的皮肤溃疡有关。
患有脊髓脊膜膨出的儿童通常存在复杂的脊柱骨盆畸形，导致皮肤溃疡。
前瞻性随访了 19 例连续的依赖轮椅的脊髓发育不良脊柱畸形患者，他们接受了脊柱手术，并进行了至少 2 年的定期压力映射。获得了标准的脊柱骨盆放射学测量值。在研究期间使用 Vista Medical（温尼伯，曼尼托巴，加拿大）的 Force Sensitive Applications 获得了坐姿压力映射。使用 SAS（SAS Institute Inc， Cary，NC）进行统计分析。使用配对 t 检验和 Wilcoxon 符号秩检验（如果适用）。显著性定义为 P<0.05。
手术显著矫正了影像学参数，特别是 Cobb 角（52%）、骨盆倾斜（89%），骨盆倾斜矫正程度较小。根据固定类型对数据进行分层显示，M-W 结构能够显著矫正骨盆倾斜。虽然手术后观察到影像学变量有显著变化，但各种压力映射变量并非如此。手术后仅观察到平均压力、最大压力和压力可变系数的微小变化。观察到的是前/后和右/左的整体分布得到改善。虽然右/左的数值仅接近统计学意义（P=0.053），但这在皮肤溃疡方面似乎没有临床意义。
尽管在影像学参数方面进行了显著的手术矫正，但这导致压力分布的微小变化，并且似乎不会影响脊髓脊膜膨出患者的皮肤溃疡。压力映射可能不是预测脊柱手术结果的有用工具。已证明影响压力分布的因素是矢状位骨盆方向和实现冠状位脊柱平衡。
