Mattila Mikko, Jalanko Tuomas, Helenius Ilkka
Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
Spine (Phila Pa 1976). 2013 Aug 15;38(18):1576-83. doi: 10.1097/BRS.0b013e31829a6d37.
A comparative review of 2 cohorts with prospective data collection.
To compare clinical and radiographical parameters in patients with adolescent idiopathic scoliosis undergoing surgery, using total pedicle screw instrumentation with and without en bloc vertebral column derotation (DVR).
All pedicle screw instrumentations with or without DVR are an effective surgical method for adolescent idiopathic scoliosis correction. However, there are limited data comparing pedicle screw instrumentation alone with pedicle screws with DVR on clinical and radiographical outcomes.
We followed 72 consecutive children and adolescents (14 males, mean age at surgery: 14.7 [range, 9.0-18.0] years; 6 juveniles, 66 adolescents) operated for a structural thoracic idiopathic scoliosis (Lenke 1-4, or 6) using all pedicle screw construct in a prospective manner for a minimum of 2 years. Of them, 24 had pedicle screw instrumentation with apical monoaxial screws without derotation (N-DVR) and 48 with en bloc DVR.
Preoperatively, the mean (SD) main thoracic curve was 56° ± 9° and 57° ± 11° and was corrected to 16° ± 6° in both groups at 2-year follow-up (not significant). Thoracic rib hump averaged 12.3° ± 3.6° versus 14.2° ± 5.0° (P = 0.075) preoperatively and 7.2° ± 3.8° versus 8.3° ± 3.7° at 2-year follow-up in the N-DVR and in the DVR both groups, respectively (P = 0.30). Correction of spinal rotation in the main thoracic curve as assessed by the Upsani score was significantly better in the DVR group than in the N-DVR group at 6 months (P = 0.038) and 2-year follow-up (P = 0.039). Thoracic kyphosis reduced from a mean of 23° ± 18° to 20° ± 9° in the N-DVR group but remained unchanged in the DVR group (P = 0.11 between groups at 2-year follow-up).
En bloc DVR has a significant effect on radiographical spinal column derotation and may help prevent flattening of thoracic kyphosis, but this derotation is not reflected by better thoracic rib hump correction at 2-year follow-up.
对两个前瞻性数据收集队列进行比较性综述。
比较接受手术治疗的青少年特发性脊柱侧凸患者的临床和影像学参数，这些患者使用了带或不带整块脊柱去旋转（DVR）的全椎弓根螺钉内固定术。
所有带或不带DVR的椎弓根螺钉内固定术都是矫正青少年特发性脊柱侧凸的有效手术方法。然而，关于单纯椎弓根螺钉内固定术与带DVR的椎弓根螺钉内固定术在临床和影像学结果方面比较的数据有限。
我们前瞻性地追踪了72例连续的儿童和青少年（14例男性，手术时平均年龄：14.7[范围，9.0 - 18.0]岁；6例青少年，66例青少年），他们因结构性胸椎特发性脊柱侧凸（Lenke 1 - 4或6型）接受了全椎弓根螺钉内固定术，随访至少2年。其中，24例采用顶端单轴螺钉无去旋转的椎弓根螺钉内固定术（N - DVR），48例采用整块DVR。
术前，两组主胸弯平均（标准差）分别为56°±9°和57°±11°，在2年随访时两组均矫正至16°±6°（无显著差异）。术前胸廓肋骨隆凸平均分别为12.3°±3.6°和14.2°±5.0°（P = 0.075），在2年随访时，N - DVR组和DVR组分别为7.2°±3.8°和8.3°±3.7°（P = 0.30）。根据Upsani评分评估，在6个月（P = 0.038）和2年随访时（P = 0.039），DVR组主胸弯的脊柱旋转矫正明显优于N - DVR组。N - DVR组胸段后凸畸形从平均23°±18°降至20°±9°，而DVR组保持不变（2年随访时两组间P = 0.11）。
整块DVR对影像学上的脊柱去旋转有显著影响，可能有助于防止胸段后凸畸形变平，但在2年随访时，这种去旋转并未体现在更好的胸廓肋骨隆凸矫正上。
二级。
