Wiedenhöfer B, Fürstenberg C H, Schröder K, Akbar M
Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Sektion Wirbelsäulenchirurgie, Klinikum der Ruprecht-Karls-Universität Heidelberg, Schlierbacher Landstr. 200a, 69118, Heidelberg, Deutschland.
Orthopade. 2011 Aug;40(8):672-81. doi: 10.1007/s00132-011-1795-5.
There is presently still no consensus on how to operatively treat adolescent idiopathic scoliosis (AIS), i.e. a clearly reduced thoracic kyphosis. For a long time the primary focus was mostly on correcting the coronal plane while neglecting the sagittal profile. Based on the current literature and own retrospective data a comprehensive review will be given on the optimal correction of the spine and how to avoid secondary complications. Different operative standard procedures are demonstrated with special attention to the sagittal balance and the special parameters sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic tilt (PT), sagittal slope (SSL) and pelvic incidence (PI).
A total of 24 patients (2 groups of 12 patients) with AIS and posterior fusion with (group A) and without (group B) additional osteotomy were analyzed with respect to the impact on spinopelvic balance and health-related quality of life (HRQoL) parameters. Patients in group A had a significant reduction of TK, LL and SSL and an increase in PT whereas patients in group B showed the opposite. Correlation analysis revealed a significant dependence of HRQoL on PT.
Both the results from the literature and own data confirm that operative correction of AIS needs a careful planning including sagittal spinopelvic parameters. Rigid thoracic hypokyphosis require additional osteotomy.
目前对于如何手术治疗青少年特发性脊柱侧凸（AIS），即明显降低的胸椎后凸，仍未达成共识。长期以来，主要关注点大多在于矫正冠状面，而忽视了矢状面形态。基于当前文献和自身回顾性数据，将对脊柱的最佳矫正方法以及如何避免继发性并发症进行全面综述。展示了不同的手术标准程序，特别关注矢状面平衡以及矢状垂直轴（SVA）、腰椎前凸（LL）、胸椎后凸（TK）、骨盆倾斜（PT）、矢状斜率（SSL）和骨盆入射角（PI）等特殊参数。
共分析了24例AIS患者（两组，每组12例），一组（A组）进行后路融合并附加截骨术，另一组（B组）未附加截骨术，分析其对脊柱骨盆平衡和健康相关生活质量（HRQoL）参数的影响。A组患者的TK、LL和SSL显著降低，PT增加，而B组患者则相反。相关性分析显示HRQoL与PT有显著相关性。
文献结果和自身数据均证实，AIS的手术矫正需要仔细规划，包括矢状面脊柱骨盆参数。严重的胸椎后凸不足需要附加截骨术。
