Etemadifar Mohammadreza, Ebrahimzadeh Alireza, Hadi Abdollah, Feizi Mehran
Department of Orthopedic Spinal Surgery, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Orthopedic, Isfahan University of Medical Sciences, Isfahan, Iran.
Eur Spine J. 2016 Aug;25(8):2580-6. doi: 10.1007/s00586-015-4234-1. Epub 2015 Sep 13.
Conventional treatment of rigid deformity in Scheuermann's kyphosis (SK) in young patients includes a preliminary anterior spinal release and fusion (ASF) followed by posterior spinal fusion and instrumentation (PSF). However, recently there are more trends to do posterior-only surgery for correction of this deformity. The aim of our study was to compare clinical and radiological outcomes of ASF/PSF and PSF-only procedures in treatment of SK.
In a prospective clinical and radiological review, thirty operated SK patients in two groups were evaluated. Group A: ASF/PSF technique (n: 16) and group B: PSF-only procedure (n: 14) were followed for at least 2 years (average 57.6 months). Two groups were well matched for the following four criteria: average age, flexibility status, posterior fusion levels, and preoperative Cobb's kyphosis angle. Oswestry disability index (ODI) and scoliosis research society questionnaire-30 (SRS-30) and radiological (kyphosis correction, correction loss, sagittal balance) parameters were evaluated before and after surgery and at the final follow-up.
In group A, primary thoracic Cobb's kyphosis, immediate post-operative kyphosis, and final follow-up kyphosis angle were 83.6°, 41.4° and 43°, respectively (P < 0.05). Correction rate and correction loss were 50.5 % and 1.6° ± 2.4, respectively. In group B, the corresponding values were 81.9°, 40.1° and 43.2°, respectively (P < 0.05). Correction rate and correction loss were 51 % and 3.1° ± 2.5, respectively. SRS-30 and ODI scores in group A were averaged 68.5 and 21.3 preoperatively and 128.7 and 6.25 at the final follow-up, respectively. In group B, the corresponding values were 64 and 23.2 preoperatively and 133.5 and 5.8 at the final follow-up, respectively.
Clinical and radiological parameters were similar in both groups after surgical correction while, complication rates, operation time and blood loss were significantly higher in ASF/PSF procedure.
年轻患者休门氏后凸畸形（SK）的传统治疗方法包括先行前路脊柱松解融合术（ASF），随后进行后路脊柱融合内固定术（PSF）。然而，近来越来越多的趋势是仅采用后路手术来矫正这种畸形。我们研究的目的是比较ASF/PSF和单纯PSF手术治疗SK的临床和影像学结果。
在一项前瞻性临床和影像学回顾研究中，对两组30例接受手术的SK患者进行了评估。A组：ASF/PSF技术（n = 16），B组：单纯PSF手术（n = 14），随访至少2年（平均57.6个月）。两组在以下四个标准上匹配良好：平均年龄、柔韧性状况、后路融合节段以及术前Cobb角后凸角度。术前、术后及末次随访时评估奥斯维斯特残疾指数（ODI）、脊柱侧弯研究协会问卷-30（SRS-30）以及影像学参数（后凸矫正、矫正丢失、矢状面平衡）。
A组中，原发胸段Cobb角后凸、术后即刻后凸及末次随访时的后凸角度分别为83.6°、41.4°和43°（P < 0.05）。矫正率和矫正丢失分别为50.5%和1.6°±2.4。B组中，相应数值分别为81.9°、40.1°和43.2°（P < 0.05）。矫正率和矫正丢失分别为51%和3.1°±2.5。A组术前SRS-30和ODI评分分别平均为68.5和21.3，末次随访时分别为128.7和6.25。B组中，相应数值术前分别为64和23.2，末次随访时分别为133.5和5.8。
手术矫正后两组的临床和影像学参数相似，而ASF/PSF手术的并发症发生率、手术时间和失血量显著更高。
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