Yu Bin, Wang Yi-peng, Qiu Gui-xing, Zhang Jian-guo, Shen Jian-xiong, Li Qi-yi, Yang Xin-yu, Zhao Li-juan
Department of Orthopedics, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China.
Zhonghua Yi Xue Za Zhi. 2009 Oct 13;89(37):2621-5.
To evaluate the different influences upon the correction outcomes after anterior or posterior correction and fusion with lowest end vertebra instrumentation in adolescent idiopathic thoracolumbar/lumbar scoliosis.
By reviewing the medical records and roentgenograms of adolescent idiopathic thoracolumbar/lumbar scoliosis patients undergoing anterior (single rod-Group A) or posterior (all pedicle screws-Group B) correction and instrumentation, the parameters of Cobb angle of the curve, correction rate and disc angle were measured and analyzed.
There were 18 patients in Group A and 21 patients in Group B. The curve included 5.0 vertebrae and 5.5 vertebrae (P = 0.134) respectively, and the fusion levels were 4.7 vertebrae and 5.4 vertebrae (P = 0.008) respectively. The mean pre-operative and post-operative coronal Cobb angles of the main curve in Groups A and B were 49.2 degrees and 10.3 degrees , 42.2 degrees and 5.0 degrees with an average correction rate of 78.5% and 87.8% respectively. The Cobb angles were all significantly corrected (all P = 0.000), and group B had a better correction result (P = 0.020). At final follow-up, the coronal Cobb angles in the two groups were 21.7 degrees and 7.7 degrees with an average correction loss of 8.3 degrees and 2.7 degrees (P = 0.001) respectively. The disc angles at pre-operation, post-operation and final follow-up were 3.1 degrees , 5.6 degrees and 7.3 degrees in Group A and 2.3 degrees , 4.2 degrees and 4.4 degrees in Group B respectively. The disc angle at post-operation was larger than that at pre-operation and the difference was significant in Group A (P = 0.049) while not in Group B (P = 0.050). The difference of post-operative disc angle between two groups was not significant (P = 0.231). At final follow-up, the disc angle was a little larger than that of post-operation without a significant difference (P = 0.112, P = 0.855) while Group A had a larger disc angle (P = 0.026). At final follow-up, the occurrence of proximal junctional kyphosis between Groups A and B was not significant (P = 0.235).
For adolescent idiopathic thoracolumbar/lumbar scoliosis, in comparison with the anterior approach, the posterior approach using all pedicle screws can achieve a better correction outcome, a less correction loss of coronal Cobb angle and a better disc angle with a longer fusion range.
评估前路或后路矫正及融合最低端椎器械固定术对青少年特发性胸腰段/腰段脊柱侧凸矫正效果的不同影响。
回顾接受前路（单棒 - A组）或后路（全椎弓根螺钉 - B组）矫正及器械固定术的青少年特发性胸腰段/腰段脊柱侧凸患者的病历和X线片，测量并分析曲线的Cobb角、矫正率和椎间盘角度参数。
A组18例患者，B组21例患者。曲线分别包含5.0个椎体和5.5个椎体（P = 0.134），融合节段分别为4.7个椎体和5.4个椎体（P = 0.008）。A组和B组主曲线术前和术后的平均冠状面Cobb角分别为49.2°和10.3°、42.2°和5.0°，平均矫正率分别为78.5%和87.8%。Cobb角均得到显著矫正（均P = 0.000），B组矫正效果更好（P = 0.020）。末次随访时，两组冠状面Cobb角分别为21.7°和7.7°，平均矫正丢失分别为8.3°和2.7°（P = 0.001）。A组术前、术后及末次随访时的椎间盘角度分别为3.1°、5.6°和7.3°，B组分别为2.3°、4.2°和4.4°。术后A组椎间盘角度大于术前，差异有统计学意义（P = 0.049），而B组差异无统计学意义（P = 0.050）。两组术后椎间盘角度差异无统计学意义（P = 0.231）。末次随访时，椎间盘角度略大于术后，但差异无统计学意义（P = 0.112，P = 0.�55），而A组椎间盘角度更大（P = 0.026）。末次随访时，A组和B组近端交界性后凸的发生率差异无统计学意义（P = 0.235）。
对于青少年特发性胸腰段/腰段脊柱侧凸，与前路手术相比，采用全椎弓根螺钉后路手术可获得更好的矫正效果、更小的冠状面Cobb角矫正丢失以及更好的椎间盘角度，且融合范围更长。
