Imagama Shiro, Ito Zenya, Wakao Norimitsu, Ando Kei, Hirano Kenichi, Tauchi Ryoji, Muramoto Akio, Matsui Hiroki, Matsumoto Tomohiro, Sakai Yoshihito, Katayama Yoshito, Matsuyama Yukihiro, Ishiguro Naoki
*Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya†Department of Orthopaedic Surgery, National Center for Geriatrics and Gerontology, Obu‡Department of Orthopaedic Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi§Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Clin Spine Surg. 2016 Oct;29(8):E376-83. doi: 10.1097/BSD.0b013e31826eaf09.
Prospective clinical case series.
To describe our surgical procedure and results for posterior correction and fusion with a hybrid approach using pedicle screws, hooks, and ultrahigh-molecular weight polyethylene tape with direct vertebral rotation (DVR) (the PSTH-DVR procedure) for treatment of adolescent idiopathic scoliosis (AIS) with satisfactory correction in the coronal and sagittal planes.
Introduction of segmental pedicle screws in posterior surgery for AIS has facilitated good correction and fusion. However, procedures using only pedicle screws have risks during screw insertion, higher costs, and decreased postoperative thoracic kyphosis. We have obtained good outcomes compared with segmental pedicle screw fixation in surgery for AIS using a relatively simple operative procedure (PSTH-DVR) that uses fewer pedicle screws.
The subjects were 30 consecutive patients with AIS who underwent the PSTH-DVR procedure and were followed for a minimum of 2 years. Preoperative flexibility, preoperative and postoperative Cobb angles, correction rates, loss of correction, thoracic kyphotic angles (T5-T12), coronal balance, sagittal balance, and shoulder balance were measured on plain radiographs. Rib hump, operation time, estimated blood loss, spinal cord monitoring findings, complications, and scoliosis research society (SRS)-22 scores were also examined.
The mean preoperative curve of 58.0 degrees (range, 40-96 degrees) was corrected to a mean of 9.9 degrees postoperatively, and the correction rate was 83.6%. Fusion was obtained in all patients without loss of correction. In 10 cases with preoperative kyphosis angles (T5-T12) <10 degrees, the preoperative mean of 5.8 degrees improved to 20.2 degrees at the final follow-up. Rib hump and coronal, sagittal and shoulder balances were also improved, and good SRS-22 scores were achieved at final follow-up.
The correction of deformity with PSTH-DVR is equivalent to that of all-pedicle screw constructs. The procedure gives favorable correction, is advantageous for kyphosis compared with segmental screw fixation, and uses the minimum number of pedicle screws. Therefore, the PSTH-DVR procedure may be useful for treatment of idiopathic scoliosis.
前瞻性临床病例系列。
描述我们采用椎弓根螺钉、钩和超高分子量聚乙烯带结合直接椎体旋转（DVR）的混合方法进行后路矫正和融合（PSTH-DVR手术）治疗青少年特发性脊柱侧凸（AIS）的手术过程及结果，该方法在冠状面和矢状面能获得满意的矫正效果。
在AIS后路手术中引入节段性椎弓根螺钉有助于实现良好的矫正和融合。然而，仅使用椎弓根螺钉的手术在螺钉置入过程中有风险、成本较高且术后胸椎后凸减小。与使用节段性椎弓根螺钉固定的AIS手术相比，我们采用一种相对简单的手术方法（PSTH-DVR），使用较少的椎弓根螺钉，取得了良好的效果。
连续30例接受PSTH-DVR手术的AIS患者，随访至少2年。在X线平片上测量术前柔韧性、术前和术后Cobb角、矫正率、矫正丢失、胸椎后凸角（T5-T12）、冠状面平衡、矢状面平衡和肩部平衡。还检查了肋骨隆起、手术时间、估计失血量、脊髓监测结果、并发症以及脊柱侧凸研究学会（SRS）-22评分。
术前平均弯曲度为58.0度（范围40-96度），术后平均矫正至9.9度，矫正率为83.6%。所有患者均实现融合，无矫正丢失。在10例术前后凸角（T5-T12）<10度的患者中，术前平均5.8度在末次随访时改善至20.2度。肋骨隆起以及冠状面、矢状面和肩部平衡也得到改善，末次随访时SRS-22评分良好。
PSTH-DVR对畸形的矫正效果与全椎弓根螺钉结构相当。该手术矫正效果良好，与节段性螺钉固定相比对后凸有利，且使用的椎弓根螺钉数量最少。因此，PSTH-DVR手术可能对特发性脊柱侧凸的治疗有用。
