单平面与固定椎弓根螺钉在青少年特发性脊柱侧凸（AIS）治疗中矫正胸椎后凸的应用比较
Uniplanar Versus Fixed Pedicle Screws in the Correction of Thoracic Kyphosis in the Treatment of Adolescent Idiopathic Scoliosis (AIS).
作者信息
Badve Siddharth A, Goodwin Ryan C, Gurd David, Kuivila Thomas, Kurra Swamy, Lavelle William F
机构信息
*Sir HN Reliance Foundation Hospital, Mumbai, India †The Cleveland Clinic, Cleveland, OH ‡SUNY Upstate Medical University, Syracuse, NY.
出版信息
J Pediatr Orthop. 2017 Dec;37(8):e558-e562. doi: 10.1097/BPO.0000000000000927.
BACKGROUND
The aim of surgical treatment of scoliosis is to obtain fusion of the spinal column, balanced in the coronal and sagittal planes. Great success has been attained with coronal correction; however, the sagittal profile has received less attention, resulting in little correction of sagittal plane alignment. The purpose of this study was to compare uniplanar and fixed pedicle screws in the correction of the thoracic sagittal alignment in the treatment of adolescent idiopathic scoliosis (AIS).
METHODS
The sagittal profile of 2 groups of patients undergoing posterior spinal fusion (PSF) for AIS was compared. One group had uniplanar screws (n=16) as bone anchors, and the second group had fixed screws (n=20). Consecutive patients with AIS treated by PSF during 2004 to 2006 with fixed screws; and those treated in 2008 with uniplanar screws were included in the study. Data included: patient demographics, medical conditions, curve type, Risser stage, coronal and sagittal curve magnitude, curve flexibility, osteotomies, fusion levels, type and location of instrumentation, curve magnitude at the initial postoperative visit and at final follow-up. ANOVA and χ testing was completed. A P<0.05 was considered significant.
RESULTS
Both groups were comparable demographically, medically, in relation to the curve characteristics and the surgical treatment. Immediate postcorrection sagittal curvature measurements were greater using the uniplanar than fixed screws, 36 versus 26 degrees and was also statistically significant at final follow-up (P=0.006). There was no difference between groups with respect to coronal thoracic deformity. In the Lenke 1 and Lenke 2 curve population, similar results were found.
CONCLUSIONS
In patients undergoing PSF for AIS, uniplanar screws achieved superior correction of the sagittal thoracic alignment than fixed screws. This advantage was maintained in the postoperative follow-up period. The ability of the uniplanar screws to adapt to variable sagittal orientation appears to contribute to better radiographic outcomes.
LEVEL OF EVIDENCE
This is a level III respective review study conducted at a single center from a single, pediatric spine surgeon.
背景
脊柱侧弯手术治疗的目的是实现脊柱融合，并在冠状面和矢状面达到平衡。在冠状面矫正方面已取得巨大成功；然而，矢状面形态受到的关注较少，导致矢状面排列的矫正效果不佳。本研究的目的是比较单平面螺钉和固定椎弓根螺钉在青少年特发性脊柱侧弯（AIS）治疗中对胸段矢状面排列的矫正效果。
方法
比较两组接受AIS后路脊柱融合术（PSF）患者的矢状面形态。一组使用单平面螺钉（n = 16）作为骨锚，另一组使用固定螺钉（n = 20）。纳入2004年至2006年期间接受PSF治疗且使用固定螺钉的连续AIS患者，以及2008年接受单平面螺钉治疗的患者。数据包括：患者人口统计学资料、医疗状况、侧弯类型、Risser分期、冠状面和矢状面侧弯度数、侧弯柔韧性、截骨术、融合节段、内固定器械类型和位置、术后首次随访及最终随访时的侧弯度数。完成方差分析和χ检验。P < 0.05被认为具有统计学意义。
结果
两组在人口统计学、医学状况、侧弯特征和手术治疗方面具有可比性。使用单平面螺钉时，矫正后即刻矢状面弯曲度测量值大于固定螺钉，分别为36度和26度，在最终随访时也具有统计学意义（P = 0.006）。两组在胸段冠状面畸形方面无差异。在Lenke 1型和Lenke 2型侧弯人群中，也发现了类似结果。
结论
在接受AIS的PSF治疗的患者中，单平面螺钉在胸段矢状面排列矫正方面优于固定螺钉。这一优势在术后随访期得以保持。单平面螺钉适应可变矢状面方向的能力似乎有助于获得更好的影像学结果。
证据水平
这是一项由单一儿科脊柱外科医生在单一中心进行的III级回顾性研究。
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