Zahi Rédoine, Thévenin-Lemoine Camille, Rogier Amélie, Constantinou Barbara, Mary Pierre, Vialle Raphaël
Department of Pediatric Orthopaedics, Armand Trousseau Hospital, Pierre and Marie Curie Paris6 University, Paris Cedex 12, France.
Childs Nerv Syst. 2011 Nov;27(11):1931-5. doi: 10.1007/s00381-011-1411-3. Epub 2011 Mar 1.
We present the results of a prospective series of 15 patients treated for neuromuscular spinal deformities with an original spinopelvic construct using two sacral screws and two iliac screws. Results were compared to a prospective cohort of 62 patients treated for neuromuscular spinal deformities by spinopelvic fixation using iliosacral screws.
From November 2005 to June 2007, the clinical data of every patient who underwent spinopelvic fixation for treatment of a neuromuscular spinal deformity were recorded prospectively.
Fifteen patients weighting less than 35 kg were operated on with a special segmental construct using two sacral screws and two iliac screws for pelvic anchorage. Sixty-two patients had spinopelvic fixation using iliosacral screws. Severity of the curve (Cobb angle) and reducibility were statistically equal in both groups. Operative time and blood loss were statistically identical in both groups. Curve correction was similar in both groups and postoperative pelvic obliquity ranged between 2° and 4°. No significant loss of correction was noted at the last follow-up. Fifteen patients had early postoperative infection of the posterior wound requiring re-operation.
Despite a high rate of infectious complications, optimal correction of pelvic obliquity requires extension of spinal instrumentation to the pelvis. Pelvic fixation with the "T-construct" did provide effective and improved spinal stabilization in these patients, while reducing the need for a postoperative cast or brace. As a result, patients had a favorable postoperative course with early mobilization and return to a comfortable sitting position.
我们展示了一组15例接受神经肌肉性脊柱畸形治疗患者的前瞻性研究结果，这些患者采用了一种使用两枚骶骨螺钉和两枚髂骨螺钉的新型脊柱骨盆固定结构。将结果与一组62例通过髂骶螺钉进行脊柱骨盆固定治疗神经肌肉性脊柱畸形的前瞻性队列进行了比较。
从2005年11月至2007年6月，前瞻性记录了每例接受脊柱骨盆固定治疗神经肌肉性脊柱畸形患者的临床数据。
15例体重小于35kg的患者接受了一种特殊的节段性结构手术，使用两枚骶骨螺钉和两枚髂骨螺钉进行骨盆固定。62例患者采用髂骶螺钉进行脊柱骨盆固定。两组患者的侧弯严重程度（Cobb角）和可矫正性在统计学上相等。两组患者的手术时间和失血量在统计学上相同。两组的侧弯矫正情况相似，术后骨盆倾斜度在2°至4°之间。在最后一次随访时未发现明显的矫正丢失。15例患者术后早期出现后伤口感染，需要再次手术。
尽管感染并发症发生率较高，但要实现骨盆倾斜度的最佳矫正，需要将脊柱内固定延伸至骨盆。采用“T形结构”进行骨盆固定确实为这些患者提供了有效的脊柱稳定，并减少了术后使用石膏或支具的需求。因此，患者术后恢复良好，能够早期活动并恢复舒适的坐姿。
