手术治疗的Lenke 1型青少年特发性脊柱侧凸中植入物的分布：它会影响侧弯矫正吗？
Implant distribution in surgically instrumented Lenke 1 adolescent idiopathic scoliosis: does it affect curve correction?
作者信息
Le Navéaux Franck, Aubin Carl-Éric, Larson A Noelle, Polly David W, Baghdadi Yaser M K, Labelle Hubert
机构信息
*Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Quebec, Canada †Research Center, Sainte-Justine University Hospital Center, Montreal, Quebec, Canada ‡Mayo Clinic, Rochester, MN; and §Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
出版信息
Spine (Phila Pa 1976). 2015 Apr 1;40(7):462-8. doi: 10.1097/BRS.0000000000000793.
STUDY DESIGN
Retrospective review of prospective multicenter database of patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion.
OBJECTIVE
To analyze implant distribution in surgically instrumented Lenke 1 patients and evaluate how it impacts curve correction.
SUMMARY OF BACKGROUND DATA
Although pedicle screw constructs have demonstrated successful surgical results, the optimal pedicle screw density and configuration remain unclear.
METHODS
A total of 279 patients with adolescent idiopathic scoliosis treated with pedicle screws were reviewed. Implant density was computed for each side of the instrumented segment, which was divided into 5 regions: distal and proximal ends (upper/lower instrumented vertebra +1 adjacent vertebra), apical region (apex ± 1 vertebra), and the 2 regions in between (upper/lower periapical). Centralized measurement of Cobb angle and thoracic kyphosis was performed on preoperative and at 1-year postoperative radiographs as well as percent curve flexibility.
RESULTS
The mean implant density was 1.66 implants per level fused (1.08 to 2) with greater available pedicles filled on the concavity (92%, 53%-100%) compared with the convex side (73%, 23%-100%, P < 0.01). The concave distal end region had the highest density with 99% of pedicles filled (P < 0.01), followed by the other concave regions and the convex distal end region (88%-94%) (P > 0.05). Other convex regions of the construct had less instrumentation, with only 54% to 78% of pedicles instrumented (P < 0.01). Implant density in the concave apical region (69%, 23%-100%) had a positive effect on curve correction (P = 0.002, R = 0.19).
CONCLUSION
Significant variability exists in implant distribution with the greatest variation on the convex side and lowest implant density used in the periapical convex regions. Only instrumentation at the concave side, particularly at the apical region, was associated with curve correction. This suggests that for a low implant density construct, the best regions for planned screw dropout may be in the periapical convexity.
LEVEL OF EVIDENCE
研究设计
对接受后路脊柱融合术的青少年特发性脊柱侧凸患者的前瞻性多中心数据库进行回顾性分析。
目的
分析接受手术治疗的Lenke 1型患者的植入物分布情况，并评估其对曲线矫正的影响。
背景资料总结
尽管椎弓根螺钉结构已显示出成功的手术效果，但最佳的椎弓根螺钉密度和配置仍不明确。
方法
回顾了279例接受椎弓根螺钉治疗的青少年特发性脊柱侧凸患者。计算器械化节段每侧的植入物密度，该节段分为5个区域：远端和近端（上下器械化椎体+1个相邻椎体）、顶区（顶点±1个椎体）以及两者之间的2个区域（上下根尖周围）。对术前和术后1年的X线片进行Cobb角和胸椎后凸的集中测量以及曲线柔韧性百分比测量。
结果
平均植入物密度为每融合节段1.66枚植入物（1.08至2枚），凹侧填充的可用椎弓根比例更高（92%，53%-100%），而凸侧为73%（23%-100%），差异有统计学意义（P<0.01）。凹侧远端区域密度最高，99%的椎弓根被填充（P<0.01），其次是其他凹侧区域和凸侧远端区域（88%-94%）（P>0.05）。结构的其他凸侧区域器械化较少，仅54%至78%的椎弓根进行了器械化（P<0.01）。凹侧顶区的植入物密度（69%，23%-100%）对曲线矫正有积极影响（P=0.002，R=0.19）。
结论
植入物分布存在显著差异，凸侧差异最大，根尖周围凸侧区域的植入物密度最低。只有凹侧的器械化，特别是顶区，与曲线矫正相关。这表明对于低植入物密度结构，计划螺钉遗漏的最佳区域可能在根尖周围凸度处。
证据级别
3级。
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