Bronx-Lebanon Hospital Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Spine (Phila Pa 1976). 2009 Oct 1;34(21):E766-74. doi: 10.1097/BRS.0b013e3181b4d558.
A retrospective study of 61 patients with cerebral palsy (CP) and neuromuscular scoliosis treated by either a combined anterior-posterior spinal arthrodesis or a posterior-only arthrodesis with the unit rod.
Compare coronal and sagittal plane radiographic outcomes in patients undergoing either a combined anterior-posterior spinal fusion (PSF) or a posterior-only fusion with the unit rod for neuromuscular scoliosis in patients with CP.
Although an anterior release before posterior spinal arthrodesis is commonly done for larger and stiffer neuromuscular curves, it is unclear whether or not an all-posterior construct produces similar correction in pelvic obliquity as that seen with an anterior-posterior spinal fusion.
Sixty-one consecutive children with CP and scoliosis were treated at a single institution between 1991 and 2003 with PSF using the unit rod with an anterior release (group A: 19 patients; average = 14.4 years) or without an anterior release (group B: 42 patients; average = 13.7 years). Side-bending, AP, and lateral radiographs were used to assess various sagittal and coronal plane parameters at baseline, after surgery, and at 2 years. RESULTS.: Before surgery, group A had larger major curves (91 degrees A vs. 72 degrees B; P = 0.001), less flexible major curves (21% A vs. 40% B; P = 0.01), with greater pelvic obliquity (26 degrees A vs. 19 degrees B, P = 0.02) than group B. In the subset of patients with a more severe preoperative pelvic obliquity (>20 degrees ), percent correction in pelvic obliquity was equivalent between groups A (71%) and B (74%, P = 0.91). With respect to coronal and sagittal plane radiographic outcomes, there were no significant group differences in major curve correction (58% A vs. 60% B), but group A trended toward greater % correction from preop bending films. At most recent follow-up, there were no differences with respect to loss of curve correction (7.6 A vs. 8.1 degrees B, P = 0.80). The rate of major complications was 26% for both groups, but group A patients had significantly longer operative times.
We demonstrate that excellent correction in severe pelvic obliquity can be achieved in smaller, more flexible curves using an all-posterior PSF, and in larger, less flexible curves using an anterior release with PSF.
回顾性研究了 61 例脑瘫（CP）合并神经肌肉性脊柱侧凸患者，这些患者分别接受了前路-后路联合脊柱融合术或后路单棒融合术治疗。
比较 CP 患者神经肌肉性脊柱侧凸行前路-后路联合脊柱融合术（PSF）或后路单棒融合术治疗时，冠状面和矢状面影像学结果。
尽管在进行后路脊柱融合术之前进行前路松解术常用于治疗更大、更僵硬的神经肌肉性脊柱侧凸，但目前尚不清楚全后路结构是否能像前路-后路脊柱融合术一样，对骨盆倾斜产生类似的矫正效果。
1991 年至 2003 年，在一家医疗机构，对 61 例 CP 合并脊柱侧凸的儿童患者进行了治疗，其中前路释放联合后路单棒融合术（A 组：19 例；平均年龄=14.4 岁）或无前路释放联合后路单棒融合术（B 组：42 例；平均年龄=13.7 岁）。使用侧位、前后位和侧位 X 线片，在基线、手术后和 2 年时评估各种矢状面和冠状面参数。
术前，A 组的主弯较大（91° A 比 72° B；P=0.001），主弯较僵硬（21% A 比 40% B；P=0.01），骨盆倾斜度较大（26° A 比 19° B，P=0.02）。在术前骨盆倾斜度较重（>20°）的患者亚组中，A 组和 B 组的骨盆倾斜矫正百分比相当（71% A 比 74% B，P=0.91）。在冠状面和矢状面影像学结果方面，两组的主弯矫正率无显著差异（58% A 比 60% B），但 A 组的术前侧位弯曲片的矫正百分比趋势更大。在最近的随访中，两组在曲线矫正丢失方面无差异（7.6° A 比 8.1° B，P=0.80）。两组的主要并发症发生率均为 26%，但 A 组患者的手术时间明显更长。
我们的研究表明，在较小、较柔韧的曲线中，采用后路 PSF 治疗可获得严重骨盆倾斜的良好矫正效果，而在较大、较僵硬的曲线中，采用前路松解联合 PSF 治疗也可获得良好的矫正效果。
