Shah Suken A, Dhawale Arjun A, Oda Jon E, Yorgova Petya, Neiss Geraldine I, Holmes Laurens, Gabos Peter G
Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
Department of Orthopaedic Surgery, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA.
Spine Deform. 2013 May;1(3):196-204. doi: 10.1016/j.jspd.2013.03.002. Epub 2013 Jun 6.
Review of prospective database.
To report the results of Ponte osteotomy with pedicle screw instrumentation for major thoracic adolescent idiopathic (AIS) curves.
Ponte osteotomy for achieving coronal and sagittal correction of major thoracic curves in AIS with pedicle screw instrumentation is a widespread technique, but results have not been well described.
Review of 87 consecutive AIS patients with Lenke 1-4 curves who underwent Ponte osteotomies and pedicle screw instrumentation by 2 surgeons at a single institution. Surgical details, blood loss, and complications were recorded. We evaluated coronal and sagittal radiological measurements and Scoliosis Research Society-22 (SRS-22) questionnaire scores over 2-year follow-up.
The mean preoperative thoracic coronal Cobb angle was 57° ± 9.7°, fulcrum flexibility was 47.2%, and lateral Cobb angle was 17.8° ± 4°. The mean estimated blood loss (EBL), expressed as percent estimated blood volume, was 35.8 ± 20.5 mL. There was significant improvement in coronal thoracic Cobb angle, percent correction, and apical vertebral translation over 2-year follow-up (p < .05). In hypokyphotic curves, there was a significant increase in lateral thoracic T5-T12 kyphosis from 8.1° to 18.3° (p < .001). In hyperkyphotic curves, mean lateral thoracic T5-T12 kyphosis improved from 45° to 26° (p < .001). Median SRS-22 domains were higher after treatment (p < .05). Complications included significant hypotension (1), EBL greater than 75% estimated blood volume (2), and wound infection needing drainage (2). There were neuromonitoring signal changes in 7 patients but no significant neurological complications.
In this case series of major thoracic AIS curves treated with segmental pedicle screw instrumentation and Ponte osteotomies, there was an improvement in the coronal and sagittal radiological parameters. A prospective controlled study is needed to determine whether pedicle screw instrumentation and Ponte osteotomies influence outcomes and complications.
前瞻性数据库回顾。
报告采用椎弓根螺钉内固定的 Ponte 截骨术治疗青少年特发性脊柱侧弯（AIS）主要胸弯的结果。
采用椎弓根螺钉内固定的 Ponte 截骨术来实现 AIS 主要胸弯的冠状面和矢状面矫正，是一种广泛应用的技术，但相关结果尚未得到充分描述。
回顾在单一机构由 2 位外科医生对 87 例连续的 Lenke 1 - 4 型 AIS 患者进行 Ponte 截骨术和椎弓根螺钉内固定的情况。记录手术细节、失血量和并发症。我们评估了 2 年随访期间的冠状面和矢状面影像学测量结果以及脊柱侧弯研究学会 22 项问卷（SRS - 22）评分。
术前胸段冠状面 Cobb 角平均为 57°±9.7°，支点柔韧性为 47.2%，侧方 Cobb 角为 17.8°±4°。以估计血容量百分比表示的平均估计失血量（EBL）为 35.8±20.5 mL。在 2 年随访期间，胸段冠状面 Cobb 角、矫正百分比和顶椎平移均有显著改善（p <.05）。在后凸不足的侧弯中，胸段 T5 - T12 侧方后凸从 8.1°显著增加至 18.3°（p <.001）。在后凸过度的侧弯中，胸段 T5 - T12 侧方后凸平均从 45°改善至 26°（p <.001）。治疗后 SRS - 22 各领域的中位数评分更高（p <.05）。并发症包括严重低血压（1 例）、EBL 大于估计血容量的 75%（2 例）以及需要引流的伤口感染（2 例）。7 例患者出现神经监测信号变化，但无严重神经并发症。
在这个采用节段性椎弓根螺钉内固定和 Ponte 截骨术治疗 AIS 主要胸弯的病例系列中，冠状面和矢状面影像学参数有所改善。需要进行一项前瞻性对照研究来确定椎弓根螺钉内固定和 Ponte 截骨术是否会影响治疗结果和并发症。
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