Liu Tie, Hai Yong
Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
J Spinal Disord Tech. 2014 Jul;27(5):277-82. doi: 10.1097/01.bsd.0000451597.91287.a0.
To compare sagittal profiles of selective posterior thoracic instrumentation with segmental pedicle screws instrumentation and hybrid (hook and pedicle screw).
Nowadays, thoracic screws are considered more effective than other constructs in spinal deformity correction and have become the treatment in adolescent idiopathic scoliosis surgery. However, recent research found that this enhanced correction ability may sacrifice sagittal balance. As lumbar lordosis is dependent upon thoracic kyphosis (TK), it has been important to maintain TK magnitude in selective thoracic fusions to keep balance. There is no sagittal measurement analysis between the hybrid and all-screw constructs type in cases of selective thoracic fusion.
All adolescent idiopathic scoliosis (Lenke1) patients surgically treated in our department between 2003 and 2008 were reviewed. Radiographs of these patients, whose preoperative, immediately postoperative, and minimum 2-year follow-up after selective thoracic fusion (lower instrumented vertebrae not lower than L1, hybrid group the pedicle screw instrumentation not higher than T10) were evaluated, 21 patients underwent posterior hybrid instrumentation and 21 underwent pedicle screw instrumentation.
No significant difference in sagittal profiles was observed between the 2 groups. At final follow-up, the proximal junctional measurement has a minor increase in both the groups. TK (T5-T12) also increased (+2.0 degrees of increase in hybrid group vs. +3.9 degrees of increase in the pedicle screw group). The effect of different instrumentation in changing TK at various time points between 2 groups was statistic different (P=0.004). Lumbar lordosis (L1-L5) was increased in both the groups. No significant changes in distal junctional measurement and thoracolumbar junction were noted. The C7 sagittal plumbline remained negative in both the groups at the final follow-up.
There was no statistically significant difference comparing the sagittal alignment parameter of pedicle screw and hybrid constructs except for selective TK correction have differences. If used properly, both kinds of instrumentation could result in acceptable sagittal profiles when selective thoracic fusions were performed.
比较选择性胸段后路内固定术（采用节段性椎弓根螺钉内固定和混合式（钩和椎弓根螺钉）内固定）的矢状面形态。
如今，在脊柱畸形矫正方面，胸段螺钉被认为比其他内固定结构更有效，并且已成为青少年特发性脊柱侧凸手术的治疗方法。然而，最近的研究发现，这种增强的矫正能力可能会牺牲矢状面平衡。由于腰椎前凸依赖于胸椎后凸（TK），因此在选择性胸段融合术中保持TK的大小对于维持平衡很重要。在选择性胸段融合病例中，尚未对混合式和全螺钉式内固定结构类型之间进行矢状面测量分析。
回顾了2003年至2008年在我科接受手术治疗的所有青少年特发性脊柱侧凸（Lenke1型）患者。对这些患者的X线片进行评估，这些患者在选择性胸段融合术后（最低固定椎体不低于L1，混合组椎弓根螺钉内固定不高于T10）的术前、术后即刻以及至少2年的随访情况，21例患者接受了后路混合式内固定，21例接受了椎弓根螺钉内固定。
两组之间在矢状面形态上未观察到显著差异。在末次随访时，两组近端交界区测量值均有轻微增加。TK（T5-T12）也增加了（混合组增加2.0度，椎弓根螺钉组增加3.9度）。两组在不同时间点改变TK的不同内固定效果具有统计学差异（P = 0.004）。两组的腰椎前凸（L1-L5）均增加。在远端交界区测量值和胸腰段交界处未观察到显著变化。在末次随访时，两组的C7矢状垂直线均为阴性。
除了在选择性TK矫正方面存在差异外，椎弓根螺钉和混合式内固定结构在矢状面排列参数上没有统计学上的显著差异。如果使用得当，在进行选择性胸段融合术时，两种内固定方式都能产生可接受的矢状面形态。
