Qiu Yong, Wang Wei-jun, Zhu Feng, Zhu Ze-zhang, Wang Bin, Yu Yang
Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China.
Zhonghua Wai Ke Za Zhi. 2011 Dec;49(12):1071-5.
To compare the results of spinal correction for severe and rigid thoracic adolescent idiopathic scoliosis (T-AIS) by combined anterior endoscopic release/posterior hybrid constructs of proximal hooks and distal pedicle screws spinal fusion (APSF) and an all-pedicle screw construct posterior-only spinal fusion (PSSF).
T-AIS patients with curves ≥ 70° and flexibility ≤ 50% who underwent APSF from November 2001 to December 2008 were retrospectively reviewed (APSF group). In addition, the patients treated by PSSF with comparable curve severity and flexibility were selected as control (PSSF group). All patients had a minimum 2-year follow-up. The thoracic curve and kyphosis were measured on standing long-cassette posteroanterior and lateral radiographs of entire spine taken at pre-operation, post-operation and last follow-up. The radiographic parameters, fusion levels, implant density and complications were compared between two groups.
There were 18 patients treated with APSF and 27 with PSSF, with mean age of (15.9 ± 2.1) years and (15.8 ± 2.9) years, respectively. In patients treated with APSF, the mean thoracic curve was 87° ± 12° with 58% ± 13% correction after operation; while in those treated with PSSF, the mean thoracic curve was 79° ± 8° with 59% ± 8% correction after operation. The number of levels fused was 12.7 ± 1.2 and 12.8 ± 1.4, while the implant density was 48% ± 5% and 61% ± 6% in APSF group and PSSF group, respectively. Patients treated with APSF and PSSF were followed by (4.5 ± 0.6) years and (2.8 ± 0.7) years, with a mean loss of correction of 4.4° and 1.9° at final follow-up. Despite the significant higher implant density found in PSSF (t = 6.123, P < 0.001), there were no statistically significant differences between the groups for gender, age, number of levels fused, preoperative coronal/sagittal Cobb measurements, coronal curve flexibility, or amount of postoperative coronal Cobb correction.
In patients with severe and rigid T-AIS, PSSF could achieve same curve correction as an APSF by increasing implant density. In treating scoliosis patients with high risk of having loss of curve correction, implant complications or pseudarthrosis, APSF is recommended to achieve solid spinal fusion.
比较采用前路内镜松解/近端钩和远端椎弓根螺钉联合后路混合结构脊柱融合术（APSF）与单纯后路全椎弓根螺钉结构脊柱融合术（PSSF）治疗重度僵硬型青少年特发性胸椎侧弯（T-AIS）的疗效。
回顾性分析2001年11月至2008年12月期间接受APSF治疗、主弯≥70°且柔韧性≤50%的T-AIS患者（APSF组）。此外，选取曲线严重程度和柔韧性相当且接受PSSF治疗的患者作为对照组（PSSF组）。所有患者均至少随访2年。在术前、术后及末次随访时拍摄全脊柱站立位长片正位和侧位X线片，测量胸椎曲线和后凸角度。比较两组的影像学参数、融合节段、植入物密度及并发症情况。
APSF组18例患者，PSSF组27例患者，平均年龄分别为（15.9±2.1）岁和（15.8±2.9）岁。APSF组患者术前平均胸椎曲线为87°±12°，术后矫正率为58%±13%；PSSF组患者术前平均胸椎曲线为79°±8°，术后矫正率为59%±8%。融合节段数分别为12.7±1.2和12.8±1.4，APSF组和PSSF组的植入物密度分别为48%±5%和61%±6%。APSF组和PSSF组患者的随访时间分别为（4.5±0.6）年和（2.8±0.7）年，末次随访时平均矫正丢失分别为4.4°和1.9°。尽管PSSF组的植入物密度显著更高（t=6.123，P<0.001），但两组在性别、年龄、融合节段数、术前冠状面/矢状面Cobb角测量值、冠状面曲线柔韧性或术后冠状面Cobb角矫正量方面无统计学显著差异。
在重度僵硬型T-AIS患者中，PSSF通过增加植入物密度可获得与APSF相同的曲线矫正效果。对于存在曲线矫正丢失、植入物并发症或假关节形成高风险的脊柱侧弯患者，推荐采用APSF以实现坚固的脊柱融合。
