Department of Neurosurgery, Tufts Medical Center, Floating Hospital for Children, Boston, MA, USA.
J Neurosurg Spine. 2012 Apr;16(4):345-50. doi: 10.3171/2011.11.SPINE11277. Epub 2012 Jan 6.
Idiopathic scoliosis is a pathological process influencing the spinal column in 3 dimensions. Initial surgical treatment focused primarily on correction in the coronal plane, and with improved instrumentation, increasing attention has targeted balancing the sagittal profile. Newer surgical techniques now permit operative corrective forces to also directly address axial rotation. Although several technical variations of direct vertebral body derotation (DVBD) have been devised, no studies have compared outcomes from the differing techniques. The purpose of this study was to describe and compare the differences between segmental and en bloc DVBD.
A large prospectively collected database was queried for patients with adolescent idiopathic scoliosis (AIS) who underwent posterior spinal fusion and for whom there was a minimum of 2 years of follow-up. In all patients some type of DVBD maneuver was performed (segmental, en bloc, or both). Any patients with concurrent thoracoplasties were excluded.
The authors identified 188 patients, of whom 120 underwent segmental derotation, 17 en bloc derotation, and 51 both. No significant radiographic or clinical differences existed among the groups preoperatively. The mean preoperative thoracic curve in the entire cohort was 53.1° ± 14.1° and the mean thoracic rib prominence was 14.0° ± 5.5°, whereas the respective postoperative values were 19.3° ± 8.3° and 7.2° ± 4.0°. No significant difference was identified between the various techniques postoperatively, either. However, when comparing intraoperative variables, significant differences were found for operative duration (p = 0.0001), estimated blood loss (p = 0.0081), and volume of blood transfusions (p = 0.041).
Although each surgical technique of DBVD may have theoretical benefits and risks, no apparent difference in outcomes was observed between techniques. The concurrent use of both techniques was associated with increased blood loss and operative duration without any appreciable benefit. The surgeon should adopt the derotation technique with which he or she is most comfortable, but concurrent use of both does not appear to improve results.
特发性脊柱侧凸是一种影响脊柱三维形态的病理过程。最初的手术治疗主要集中在冠状面的矫正上，随着器械的改进，越来越多的注意力集中在平衡矢状位轮廓上。现在，新的手术技术可以使手术矫正力直接针对轴向旋转。尽管已经设计了几种直接椎体旋转（DVBD）的技术变化，但没有研究比较不同技术的结果。本研究的目的是描述和比较节段性和整块 DVBD 之间的差异。
对接受后路脊柱融合术且随访时间至少 2 年的青少年特发性脊柱侧凸（AIS）患者的大型前瞻性数据库进行了查询。所有患者均行某种类型的 DVBD 手术（节段性、整块或两者兼有）。排除同时行胸廓成形术的患者。
作者共纳入 188 例患者，其中 120 例行节段性旋转，17 例行整块旋转，51 例行两者兼有。术前各组患者在影像学和临床方面无显著差异。整个队列的术前平均胸弯为 53.1°±14.1°，平均肋骨隆起 14.0°±5.5°，术后分别为 19.3°±8.3°和 7.2°±4.0°。术后各种技术之间也没有发现明显的差异。然而，当比较术中变量时，手术时间（p=0.0001）、估计失血量（p=0.0081）和输血量（p=0.041）有显著差异。
尽管每种 DBVD 手术技术都可能有其理论上的优点和风险，但在各种技术之间没有观察到明显的结果差异。同时使用两种技术会增加出血量和手术时间，但没有明显的获益。外科医生应采用他或她最熟悉的旋转技术，但同时使用两种技术似乎并不能改善结果。
