Shi Zhicai, Chen Jiayu, Wang Chao, Li Ming, Li Quan, Zhang Ye, Li Cheng, Qiao Yuehua, Kaijin Guo, Xiangyang Chen, Ran Bo
*Department of Orthopaedics, Changhai Hospital Affiliated to the Second Medical University, Shanghai †Department of Orthopedics, Kunming General Hospital of Chengdu Military Command, Kunming ‡Department of Orthopedic Injury, General Hospital of Jinan Military Command, Jinan, Shandong Province §Department of Orthopedics, People's Liberation Army 161 Hospital, Wuhan, Hubei Province ∥Department of Orthopedics, The Affiliated Hospital of Xuzhou Medical College ¶Teaching and Research Department of Otorhinolaryngology, The Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu Province, China.
J Spinal Disord Tech. 2015 Oct;28(8):E454-9. doi: 10.1097/BSD.0b013e3182a2658a.
To compare the effect of thoracoscopic anterior release combined with posterior spinal fusion and posterior-only approach with an all-pedicle screw construct in the treatment of rigid thoracic adolescent idiopathic scoliosis.
From June 2001 to June 2010, 63 patients who were admitted to our hospital with thoracic Cobb angle ≥80 degrees and the flexibility ≤40% were enrolled in our study. They were treated with either a combined anterior/posterior spinal fusion with hooks and screws (group A, n=25) or a posterior spinal fusion alone with an all-pedicle screw construct (group B, n=38). The thoracic Cobb angle in the standing whole-spine anteroposterior x-ray, thoracic kyphosis (T5-T12) Cobb angle, imaging examination parameters, fixation segments, implant density, and complications between the 2 groups were compared.
There were no significant differences in operation time, bleeding volume, length of hospital stay, preoperative coronal, sagittal Cobb, coronal curve flexibility, or postoperative coronal Cobb correction ratio between the 2 groups. Moreover, no significant difference in the Scoliosis Research Society-22 score at the last follow-up was present in the 2 groups, although it had been improved compared with that presented during the preoperative period. The implant density of group A (44±4%) was significantly lower than that of group B (55±5%) (P<0.001). In group A, the main complication was chylothorax (n=2) and hemopneumothorax (n=2). In group B, acute intestinal obstruction was observed in 2 patients and pleural effusion was observed in 1 patient. In addition, 12 screws were misplaced (12/403, 3.0%) in group B.
In patients with rigid thoracic adolescent idiopathic scoliosis, posterior-only approach with an all-pedicle screw construct could achieve the same curve correction as a combined anterior/posterior spinal fusion by increasing the implant density. However, for scoliosis patients with a high risk of implant complications, anterior release combined with posterior spinal fusion is still recommended.
比较胸腔镜前路松解联合后路脊柱融合术与单纯后路全椎弓根螺钉内固定术治疗僵硬型青少年特发性胸椎侧弯的效果。
2001年6月至2010年6月，我院收治的63例胸椎Cobb角≥80度且柔韧性≤40%的患者纳入研究。其中25例采用前路/后路脊柱融合术联合钩钉固定（A组），38例采用单纯后路全椎弓根螺钉内固定术（B组）。比较两组患者站立位全脊柱正位X线片上的胸椎Cobb角、胸椎后凸（T5-T12）Cobb角、影像学检查参数、固定节段、植入物密度及并发症情况。
两组患者手术时间、出血量、住院时间、术前冠状面及矢状面Cobb角、冠状面弯曲柔韧性或术后冠状面Cobb角矫正率比较，差异均无统计学意义。此外，两组末次随访时脊柱侧弯研究学会-22评分较术前均有改善，但差异无统计学意义。A组植入物密度（44±4%）显著低于B组（55±5%）（P<0.001）。A组主要并发症为乳糜胸（2例）和血气胸（2例）。B组2例患者出现急性肠梗阻，1例患者出现胸腔积液。此外，B组有12枚螺钉位置不当（12/403，3.0%）。
对于僵硬型青少年特发性胸椎侧弯患者，单纯后路全椎弓根螺钉内固定术通过增加植入物密度可达到与前路/后路脊柱融合术相同的矫正效果。然而，对于植入物并发症风险较高的脊柱侧弯患者，仍建议采用前路松解联合后路脊柱融合术。
