Matsumoto Morio, Watanabe Kota, Ogura Yoji, Okada Eijiro, Hosogane Naobumi, Chiba Kazuhiro, Toyama Yoshiaki
Department of Orthopaedic Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Spinal Disord Tech. 2013 Apr;26(2):93-7. doi: 10.1097/BSD.0b013e31823ac2e8.
A retrospective case-control study
Short fusion using pedicle screws (PSs) with an attempt to attain maximum correction of the main thoracic curve was conducted for patients with a Lenke type 1 curve, to prevent postoperative left shoulder elevation. The outcomes were compared with those of conventional surgery.
Excessive correction of the main thoracic curve by PSs causes problematic left shoulder elevation even in a Lenke type 1 curve.
Thirty-eight patients (3 male, 35 female, mean age 16.2 years, mean follow-up 24 mo) with Lenke type 1 curve underwent posterior corrective surgery using PSs. The upper instrumented vertebra was 1 level below the end vertebra in 14 patients (short, S group), and it was at the end vertebra in 24 patients (conventional, C group). There was no difference in the preoperative Cobb angle (51.8 vs. 58.0) or curve flexibility (49.7 vs. 46.1) between the 2 groups. Radiographic results, perioperative data, and scoliosis research society 22 scores were compared between the 2 groups.
The postoperative Cobb angle of the main curve after surgery was 13.2±5.7 degrees in the S group and 10.6±7.3 degrees in the C group (not significant). The clavicle angle was -2.1±2.8 degrees versus -2.7±2.6 degrees before surgery (not significant), and 0.8±2.3 versus 3.8±2.4 after surgery (P<0.05). The number of fused vertebrae, mean surgical time, and estimated blood loss were significantly lower in the S group than in the C group. The scoliosis research society 22 score at follow-up was not different between the 2 groups.
The short fusion strategy for a Lenke type 1 curve can produce equivalent correction of the main curve and clinical outcomes to conventional fusion strategy with less surgical time and blood loss, while maintaining better shoulder balance.
一项回顾性病例对照研究
对Lenke 1型曲线患者采用椎弓根螺钉（PSs）进行短节段融合，试图最大程度矫正胸主弯，以防止术后左肩抬高。将结果与传统手术的结果进行比较。
即使在Lenke 1型曲线中，PSs过度矫正胸主弯也会导致有问题的左肩抬高。
38例Lenke 1型曲线患者（男3例，女35例，平均年龄16.2岁，平均随访24个月）接受了使用PSs的后路矫正手术。14例患者（短节段组，S组）的上固定椎比终椎低1个节段，24例患者（传统组，C组）的上固定椎为终椎。两组术前Cobb角（51.8对58.0）或曲线柔韧性（49.7对46.1）无差异。比较两组的影像学结果、围手术期数据和脊柱侧凸研究学会22分。
S组术后主弯的Cobb角为13.2±5.7度，C组为10.6±7.3度（无显著性差异）。锁骨角术前为-2.1±2.8度对-2.7±2.6度（无显著性差异），术后为0.8±2.3对3.8±2.4（P<0.05）。S组融合椎体数、平均手术时间和估计失血量显著低于C组。随访时两组的脊柱侧凸研究学会22分无差异。
Lenke 1型曲线的短节段融合策略在减少手术时间和失血量的同时，能产生与传统融合策略相当的主弯矫正效果和临床结果，同时保持更好的肩部平衡。
