Department of Orthopaedic Surgery, the Affiliated Changhai Hospital of the Second Military Medical University, Shanghai, China.
Spine (Phila Pa 1976). 2017 Aug 15;42(16):1226-1232. doi: 10.1097/BRS.0000000000002143.
A retrospective clinical and radiographic study.
The aim of this study was to evaluate outcomes of the key vertebral pedicle screw strategy (KVPSS) for the correction of flexible Lenke type 1 adolescent idiopathic scoliosis (AIS) with a minimum follow-up of 5 years.
The KVPSS has been described as an alternative screw placement strategy for surgically treating the main thoracic curve in AIS patients. However, there have been no long-term, three-dimensional correction studies of selective thoracic fusion using the KVPSS in Lenke type 1AIS.
Twenty consecutive patients with Lenke type 1 main thoracic AIS underwent one-stage posterior correction and fusion using the KVPSS. Preoperative and postoperative radiographic and clinical parameters were analyzed.
The mean preoperative major thoracic curve was 47.4° ± 5.8°, and mean corrections of 67.0%, 63.4%, and 61.5% were observed at the immediate, 2-year postoperative, and final follow-ups, respectively. Thoracickyphosis decreased significantly from the preoperative period to the immediate postoperative period (P = 0.042) but did not change significantly from the 2-year postoperative follow-up to the final follow-up (P = 0.067). Apical vertebral rotation achieved 34.7% correction and exhibited correction loss of 8.2% at the final follow-up. The average intraoperative blood loss was 802.3 mL, and the mean operative time was 138.6 minutes. SRS-22 scores for self-image and satisfaction improved significantly from the preoperative period to the final follow-up. No neurologic or implant-associated complications were observed in this study.
The KVPSS is an effective method for correcting Lenke type 1 AIS and achieves satisfactory correction of the deformity. Relative to other approaches, the KVPSS can not only achieve a satisfactory and cost-effective clinical outcome but also reduce both operative time and intraoperative blood loss.
回顾性临床和影像学研究。
本研究旨在评估关键椎弓根螺钉策略（KVPSS）治疗 Lenke 1 型青少年特发性脊柱侧凸（AIS）的结果，患者的随访时间至少为 5 年。
KVPSS 已被描述为治疗 AIS 患者主胸弯的另一种螺钉放置策略。然而，对于 Lenke 1AIS 采用选择性胸椎融合的 KVPSS 进行长期三维矫正研究尚未见报道。
连续 20 例 Lenke 1 型主胸 AIS 患者接受一期后路矫正融合，采用 KVPSS。分析术前和术后影像学和临床参数。
术前主胸弯平均为 47.4°±5.8°，即刻、术后 2 年随访和最终随访时的平均矫正率分别为 67.0%、63.4%和 61.5%。胸腰后凸从术前到即刻术后显著减小（P=0.042），但从术后 2 年随访到最终随访时没有明显变化（P=0.067）。顶椎旋转矫正 34.7%，最终随访时矫正丢失 8.2%。术中平均失血量为 802.3ml，平均手术时间为 138.6 分钟。SRS-22 自我形象和满意度评分从术前到最终随访显著提高。本研究中未观察到神经或植入物相关并发症。
KVPSS 是治疗 Lenke 1 型 AIS 的有效方法，可获得满意的畸形矫正。与其他方法相比，KVPSS 不仅可以获得满意的、具有成本效益的临床效果，而且可以减少手术时间和术中失血量。
4 级
