Sale de Gauzy Jérôme, Jouve Jean-Luc, Accadbled Franck, Blondel Benjamin, Bollini Gérard
J Child Orthop. 2011 Aug;5(4):273-82. doi: 10.1007/s11832-011-0357-z. Epub 2011 Jul 13.
Among posterior surgical techniques for treating adolescent idiopathic scoliosis (AIS), hybrid constructs with pedicle-screw fixation in the lumbar spine and other anchors in the thoracic spine have been reported to provide to be of more physiological value in postoperative thoracic kyphosis than all-screw constructs. The Universial Clamp (UC) equipped with a soft sublaminar band is a relatively new thoracic anchor that can be used in hybrid constructs. A dedicated reduction tool that applies traction to the sublaminar band permits gentle translation of the thoracic curve to the precontoured fusion rods, which have been previously anchored distally by pedicle screws and proximally by hooks in a claw configuration. The aim of this study was to evaluate radiographic results of AIS treatment using UC hybrid constructs.
This was a prospective case series in which 29 consecutive patients with Lenke type 1, 2 or 3 AIS operated on by two surgeons in two centers were followed for 24 months. Necessity for anterior release was an exclusion criterion.
A total of 5.4 ± 1.4 UCs were used per patient. The major thoracic curve was reduced from 55 ± 7° to 14 ± 6° at 1 month and 17 ± 6° at 24 months (correction 70%) without complications. In the patients who had less than 20° of T5-T12 kyphosis preoperatively, thoracic kyphosis improved from 14 ± 4° to 20 ± 3° at 3 months and 24 ± 9° at 24 months. In the other patients, preoperative thoracic kyphosis (27° ± 6°) was unchanged by the operation.
UC hybrid constructs appear to safely provide satisfying coronal correction while consistently improving thoracic kyphosis in patients who also have preoperative hypokyphosis. We hypothesize that diminution in thoracic kyphosis was consistently avoided due to the straightforward traction of the spine to the fusion rods into which the chosen kyphosis was contoured by the surgeon before applying the reduction tool to the sublaminar bands.
在治疗青少年特发性脊柱侧凸（AIS）的后路手术技术中，据报道，腰椎采用椎弓根螺钉固定、胸椎采用其他锚定方式的混合结构，与全螺钉结构相比，在术后胸椎后凸方面具有更高的生理价值。配备软椎板下带的通用夹（UC）是一种相对较新的胸椎锚定装置，可用于混合结构。一种专门的复位工具，通过对椎板下带施加牵引力，可使胸椎曲线轻柔地平移至预弯的融合棒上，融合棒先前已在远端通过椎弓根螺钉、近端通过爪形钩进行了固定。本研究的目的是评估使用UC混合结构治疗AIS的影像学结果。
这是一个前瞻性病例系列研究，连续纳入了29例Lenke 1、2或3型AIS患者，由两个中心的两位外科医生进行手术，并随访24个月。是否需要前路松解作为排除标准。
每位患者平均使用5.4±1.4个UC。主胸弯在术后1个月从55±7°减小至14±6°，24个月时为17±6°（矫正率70%），且无并发症。术前T5 - T12后凸小于20°的患者，胸椎后凸在术后3个月从14±4°改善至20±3°，24个月时为24±9°。其他患者术前的胸椎后凸（27°±6°）术后无变化。
UC混合结构似乎能安全地提供令人满意的冠状面矫正，同时持续改善术前存在后凸不足患者的胸椎后凸。我们推测，由于在对椎板下带应用复位工具之前，脊柱被直接牵引至外科医生已按选定后凸进行塑形的融合棒上，因此始终避免了胸椎后凸的减小。
