Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN 55454, USA.
J Bone Joint Surg Am. 2011 Jul 6;93(13):1227-34. doi: 10.2106/JBJS.J.00678.
Pedicle screws are widely used in spinal surgery. There is extensive published literature concerning the use of pedicle screw instrumentation for spinal surgery in adults. Now there is a trend to use pedicle screws in pediatric patients, including the very young. A systematic review of the current English-language literature on the use of pedicle screw instrumentation in the pediatric age group was performed to specifically determine (1) the pedicle screw placement accuracy in patients with spine deformity and (2) the effect size of all-pedicle screw constructs compared with other methods of spinal instrumentation in terms of the percentage of scoliosis correction.
English-language studies of pedicle screw use in pediatric patients (defined as those younger than eighteen years of age) were included. Descriptive statistics synthesized the accuracy of pedicle screw placement. Accuracy rates were compared between pediatric and adult patients. The effect of pedicle screw instrumentation on scoliosis correction was calculated with use of Cobb angle measurements.
On the basis of the literature search, 1181 articles were screened, 320 abstracts were examined, and ninety full-text articles representing 5761 patients were reviewed in detail. Seventeen studies met the inclusion criteria for the analysis of pedicle screw placement accuracy. A total of 13,536 pedicle screws were placed in 1353 pediatric patients. The overall placement accuracy rate in pediatric patients was 94.9%, which was higher than the rate of 91.5% reported for adults. The weighted, geometric, and 5% trimmed mean accuracy rates of pedicle screw placement were 91.9%, 88.5%, and 89.1%, respectively (standard deviation = 10%; interquartile range = 10%). Sixteen comparative studies met the inclusion criteria for the analysis of the effect of pedicle screw instrumentation on scoliosis correction. Pedicle screw constructs had a significantly larger percentage of Cobb angle correction compared with hooks (Cohen's d = 1.14) and hybrid constructs (Cohen's d = 0.49).
The accuracy of pedicle screw placement in the pediatric spine exceeds the accuracy rate reported in adults. Pedicle screw instrumentation constructs are significantly more effective for scoliosis correction, as determined on the basis of Cobb angle measurements, than are hook constructs and hybrid constructs.
椎弓根螺钉在脊柱手术中被广泛应用。目前已有大量关于成人脊柱手术中使用椎弓根螺钉器械的文献报道。现在，在儿科患者中使用椎弓根螺钉的趋势越来越明显，包括非常年幼的患者。我们对当前关于在儿科年龄段使用椎弓根螺钉器械的英文文献进行了系统性回顾，以专门确定：（1）脊柱畸形患者椎弓根螺钉的放置准确性；（2）与其他脊柱器械固定方法相比，全椎弓根螺钉结构在脊柱侧凸矫正方面的效应大小（以脊柱侧凸矫正百分比表示）。
纳入了研究椎弓根螺钉在儿科患者（定义为年龄小于 18 岁的患者）中应用的英文文献。对椎弓根螺钉放置的准确性进行了描述性统计分析。比较了儿科患者和成年患者的椎弓根螺钉放置准确率。使用 Cobb 角测量值计算椎弓根螺钉器械对脊柱侧凸矫正的影响。
通过文献检索，共筛选出 1181 篇文章，对 320 篇摘要进行了检查，并详细审查了 90 篇全文文章，共涉及 5761 例患者。17 项研究符合分析椎弓根螺钉放置准确性的纳入标准。共在 1353 例儿科患者中置入了 13536 枚椎弓根螺钉。儿科患者的总体放置准确率为 94.9%，高于成年患者的 91.5%。椎弓根螺钉放置的加权、几何和 5%修剪均数准确率分别为 91.9%、88.5%和 89.1%（标准差=10%；四分位间距=10%）。符合分析椎弓根螺钉器械对脊柱侧凸矫正影响的纳入标准的 16 项比较研究。与钩（Cohen's d = 1.14）和混合结构（Cohen's d = 0.49）相比，椎弓根螺钉结构在 Cobb 角测量方面矫正脊柱侧凸的效果显著更大。
儿科脊柱中椎弓根螺钉的放置准确性超过了成年患者的报告水平。基于 Cobb 角测量值，椎弓根螺钉器械结构在脊柱侧凸矫正方面的效果明显优于钩结构和混合结构。
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