Courvoisier Aurélien, Garin Christophe, Vialle Raphaël, Kohler Rémi
Department of Paediatric Orthopaedics, Grenoble University Hospital, Grenoble Alpes University, TIMC-IMAG-SPM, .
Department of Paediatric Orthopaedics, Hôpital Couple Enfant, BP 217 38043, Cedex 09 Grenoble, France.
Childs Nerv Syst. 2015 Dec;31(12):2325-31. doi: 10.1007/s00381-015-2891-3. Epub 2015 Sep 4.
Agreement between the correction objectives and the instrumentation strategies remains controversial in idiopathic scoliosis. Most studies have focus on the frontal and sagittal plane. The goal of this study was to evaluate the change on vertebral axial rotation after posterior instrumentation in fused and unfused segments.
Fourteen patients operated on for idiopathic scoliosis were prospectively included. Fusion and instrumentation were done by posterior approach. All patients had a pre-operative and a 10-day post-operative radiological evaluation with the EOS system. Axial orientation of the vertebrae with special interest to the apical, junctional, and unfused areas was obtained thanks to the reconstruction software.
Mean apical vertebra axial rotation statistically decreased from 21° pre-operatively to 13° post-operatively. But, there were no statistically significant differences between pre-operative and post-operative mean axial intervertebral rotations in the main curve and axial rotation of the non-instrumented lower counter curve.
3D analysis of the spine in standing position is a great advancement for post-operative analysis of adolescent idiopathic scoliosis (AIS) corrections. This study confirmed that actual instrumentations are able to achieve "en bloc" 3D correction of the spine but not intervertebral axial rotation correction.
在特发性脊柱侧凸中，矫正目标与器械策略之间的一致性仍存在争议。大多数研究集中在矢状面和冠状面。本研究的目的是评估后路器械固定术后融合节段和未融合节段椎体轴向旋转的变化。
前瞻性纳入14例行特发性脊柱侧凸手术的患者。通过后路进行融合和器械固定。所有患者术前及术后10天均采用EOS系统进行影像学评估。借助重建软件获得对顶椎、交界区和未融合区特别感兴趣的椎体的轴向定位。
平均顶椎轴向旋转角度从术前的21°统计学上显著降至术后的13°。但是，主弯术前和术后的平均椎间轴向旋转以及未器械固定的下反曲弯的轴向旋转在统计学上没有显著差异。
站立位脊柱的三维分析是青少年特发性脊柱侧凸（AIS）术后分析的一大进步。本研究证实，实际的器械固定能够实现脊柱的“整体”三维矫正，但不能矫正椎间轴向旋转。
