Pizones Javier, Sánchez-Mariscal Felisa, Zúñiga Lorenzo, Izquierdo Enrique
Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario de Getafe, Carretera de Toledo Km. 12.5, 28905, Getafe, Madrid, Spain,
Eur Spine J. 2015 Jul;24(7):1540-6. doi: 10.1007/s00586-014-3749-1. Epub 2015 Jan 7.
There is controversy regarding the effect of the Ponte osteotomies in the improvement of coronal correction, its maintenance during follow-up, and the restoration of thoracic kyphosis in adolescent idiopathic scoliosis (AIS).
Seventy-three AIS patients with Lenke type 1-4 curves were included. A prospective description of 43 consecutive patients who underwent apical Ponte osteotomies and sublaminar wires with hybrid instrumentation was retrospectively compared to a historical cohort of 30 patients without "Ponte osteotomies". The surgical details and complications were recorded. We evaluated the radiological measurements and SRS-22 Questionnaire scores over a 2-year follow-up.
The Ponte group achieved better postoperative (70 vs 57 %) and final (62 vs 50 %) main curve correction P < 0.001, with no significant loss of correction (4.2° vs 2.5°) P = 0.2 at the final follow-up (48 vs 106 months). We did not find a difference in thoracic (T5-T12) postoperative (22° vs 24°) and final (25° vs 26°) mean kyphosis angle. However, the "Ponte osteotomies" helped to achieve a normal sagittal profile, increasing preoperative hypokyphotic curves (<10°) from 6° to 17° (control: 9°-12°; P = 0.01); and preoperative hyperkyphotic curves (>40°) from 52° to 26° (control: 46°-39°; P = 0.01). The length of surgery was similar (4.3 vs 4.6 h), as were the SRS-22 scores. No major complications were found.
Ponte osteotomies in major thoracic AIS curves treated by sublaminar wires allowed more effective corrective maneuvers, which improved coronal correction without a significant loss during follow-up. The sagittal profile appears to be determined by other variables; however, "Ponte osteotomies" facilitate the contouring of the desired kyphosis.
关于 Ponte 截骨术在青少年特发性脊柱侧凸（AIS）中改善冠状面矫正、随访期间维持矫正以及恢复胸椎后凸方面的效果存在争议。
纳入 73 例 Lenke 1 - 4 型曲线的 AIS 患者。对 43 例连续接受顶椎 Ponte 截骨术及椎板下钢丝联合混合内固定术的患者进行前瞻性描述，并与 30 例未行“Ponte 截骨术”的历史队列患者进行回顾性比较。记录手术细节及并发症。我们在 2 年随访期间评估了放射学测量结果及 SRS - 22 问卷评分。
Ponte 组术后（70%对 57%）及末次随访时（62%对 50%）主弯矫正效果更好（P < 0.001），末次随访时（48 个月对 106 个月）矫正丢失不显著（4.2°对 2.5°，P = 0.2）。我们未发现胸椎（T5 - T12）术后（22°对 24°）及末次随访时（25°对 26°）平均后凸角存在差异。然而，“Ponte 截骨术”有助于实现正常矢状面形态，使术前低后凸曲线（<10°）从 6°增加至 17°（对照组：9° - 12°；P = 0.01）；术前高后凸曲线（>40°）从 52°降至 26°（对照组：46° - 39°；P = 0.01）。手术时长相似（4.3 小时对 4.6 小时），SRS - 22 评分也相似。未发现重大并发症。
对于采用椎板下钢丝治疗的主要胸椎 AIS 曲线，Ponte 截骨术能实现更有效的矫正操作，改善冠状面矫正且随访期间无显著丢失。矢状面形态似乎由其他变量决定；然而，“Ponte 截骨术”有助于塑造理想的后凸形态。
