Lykissas Marios G, Sharma Vivek, V Jain Viral, Crawford Alvin H
Cincinnati Children's Hospital Medical Center, Division of Orthopaedic Surgery, University of Cincinnati, Cincinnati, OH.
J Spinal Disord Tech. 2015 May;28(4):134-9. doi: 10.1097/BSD.0b013e3182745f51.
Level III-therapeutic study.
The purpose of this study was to determine whether the addition of costoplasty in adolescent idiopathic scoliosis surgery improved correction of the rib hump deformity.
Trunk deformity is comprised of vertebral rotation, posterior vertebral element, and rib deformities. Surgical correction of the rotational deformity has been performed by segmental spinal instrumentation with vertebral derotation, but complete correction of the rib hump by derotation is rarely achieved.
A multicenter registry database for adolescent idiopathic scoliosis was reviewed with the inclusion criteria of Lenke type I curves treated with posterior spinal fusion with or without costoplasty, instrumented with pedicle screws or hybrid constructs, with a minimum follow-up of 2 years. The first group (group I) was treated with pedicle screws, direct vertebral rotation, and no costoplasty, whereas the second group (group II) was treated with pedicle screws, vertebral rotation, and costoplasty. The rib index (RI), calculated from the double rib contour sign, and Cobb angle were measured radiographically and compared between groups.
The groups comprised 36 subjects in group I and 40 subjects in group II. The mean preoperative Cobb angles for groups I and II were 49.7 and 49.8 degrees, respectively, whereas the mean postoperative Cobb angles were 10.2 and 10.9 degrees, respectively. There was no difference in preoperative and postoperative values when comparing both groups (P=0.48 and 0.96, respectively). Before spine surgery, RI for groups I and II was 1.61 and 1.80, respectively. Postoperatively, the rib indices were 1.39 for group I and 1.29 for group II. These differences were found to be statistically significant (P=0.002 and 0.006, respectively). The amounts of correction of RI were 0.23 and 0.51 for groups I and II, respectively. This difference was found to be statistically significant (P<0.0001). The correction percentages were 13.7% and 28.3%, respectively. This difference was also found to be statistically significant (P<0.0001).
Costoplasty combined with pedicle screws and vertebral derotation may significantly improve rib hump deformity as opposed to pedicle screws and vertebral derotation alone.
III级治疗性研究。
本研究旨在确定在青少年特发性脊柱侧凸手术中增加肋骨成形术是否能改善肋骨隆起畸形的矫正效果。
躯干畸形包括椎体旋转、椎体后部结构及肋骨畸形。通过节段性脊柱内固定结合椎体去旋转来手术矫正旋转畸形，但通过去旋转完全矫正肋骨隆起的情况很少见。
回顾了一个青少年特发性脊柱侧凸的多中心注册数据库，纳入标准为Lenke I型曲线，采用后路脊柱融合术，有或无肋骨成形术，使用椎弓根螺钉或混合结构，最低随访2年。第一组（I组）采用椎弓根螺钉、直接椎体去旋转且无肋骨成形术，而第二组（II组）采用椎弓根螺钉、椎体去旋转及肋骨成形术。通过双肋骨轮廓征计算肋骨指数（RI），并进行影像学测量Cobb角，比较两组结果。
I组有36例受试者，II组有40例受试者。I组和II组术前平均Cobb角分别为49.7度和49.8度，而术后平均Cobb角分别为10.2度和10.9度。两组术前和术后值比较无差异（P值分别为0.48和0.96）。脊柱手术前，I组和II组的RI分别为1.61和1.80。术后，I组肋骨指数为1.39，II组为1.29。这些差异具有统计学意义（P值分别为0.002和0.006）。I组和II组RI的矫正量分别为0.23和0.51。该差异具有统计学意义（P<0.0001）。矫正百分比分别为13.7%和28.3%。该差异也具有统计学意义（P<0.0001）。
与单纯使用椎弓根螺钉和椎体去旋转相比，肋骨成形术联合椎弓根螺钉和椎体去旋转可显著改善肋骨隆起畸形。
