Wu Xinghuo, Yang Shuhua, Xu Weihua, Yang Cao, Ye Shunan, Liu Xianzhe, Li Jin, Wang Jing
Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Spinal Disord Tech. 2010 Oct;23(7):467-73. doi: 10.1097/BSD.0b013e3181bf6797.
Prospective cohort study.
To comprehensively compare the intermediate and long-term results of posterior correction and fusion with segmental pedicle screw instrumentation versus those with hook constructs in idiopathic adolescent thoracic scoliosis.
Posterior correction and fusion represent the current standard surgical treatment in progressive idiopathic thoracic scoliosis. The 3-column fixation of pedicle screws has been shown to be superior to all other posterior spinal fixation devices.
A total of 168 patients with idiopathic thoracic scoliosis at a single institution who underwent a posterior spinal fusion with segmental pedicle screw (88) or a combination of hooks and pedicle screws (80) instrumentation. Patient's evaluation consisted of clinical and radiographic analysis preoperatively, postoperatively, and at final follow-up.
All patients were prospectively evaluated with an average follow-up of 5 years (range 5 to 11 y). The average number of segments in the fusion was 9.1 (range 6 to 15) in the hook group and 8.5 in the screw group (range 5 to 12). At the final follow-up, the amount of loss of correction in thoracic curves averaged 8.4 in the hook group and 5.3 in the screw group. The difference between the mean postoperative Cobb angle and the final Cobb angle of the major curves with a preoperative value was statistically significant in the 2 groups (P<0.01). The frontal and sagittal plane correction can be satisfactorily obtained by the screw group versus the pedicle screw group. There were no cases of pseudarthrosis, deep wound infections, or any neurologic complications.
Satisfactory correction and maintenance of scoliotic curves could be obtained by pedicle screw instrumentation compared with hook constructs. Thoracic and thoracolumbar pedicle screw instrumentation is a safe and reliable method for obtaining rigid segmental spinal fixation over the conventional hook and rod.
前瞻性队列研究。
全面比较后路矫正融合术联合节段性椎弓根螺钉内固定与钩形结构内固定治疗特发性青少年胸椎侧弯的中长期疗效。
后路矫正融合术是目前治疗进展性特发性胸椎侧弯的标准手术方法。已证实椎弓根螺钉的三柱固定优于所有其他后路脊柱固定装置。
在单一机构中，共有168例特发性胸椎侧弯患者接受了后路脊柱融合术，其中88例采用节段性椎弓根螺钉内固定，80例采用钩与椎弓根螺钉联合内固定。对患者的评估包括术前、术后及末次随访时的临床和影像学分析。
所有患者均接受前瞻性评估，平均随访5年（范围5至11年）。钩形结构组融合节段的平均数量为9.1个（范围6至15个），螺钉组为8.5个（范围5至12个）。在末次随访时，钩形结构组胸椎曲线矫正丢失量平均为8.4，螺钉组为5.3。两组主要曲线术后平均Cobb角与术前值相比的最终Cobb角差异具有统计学意义（P<0.01）。与钩形结构组相比，螺钉组在矢状面和冠状面的矫正效果更理想。未出现假关节、深部伤口感染或任何神经并发症病例。
与钩形结构相比，椎弓根螺钉内固定能获得满意的侧弯矫正效果并维持矫正。与传统的钩棒系统相比，胸段和胸腰段椎弓根螺钉内固定是一种安全可靠的获得脊柱节段性坚强固定的方法。
