Shen Mingkui, Jiang Honghui, Luo Ming, Wang Wengang, Li Ning, Wang Lulu, Xia Lei
Institute of Spinal Deformity, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China.
Department of Orthopaedic Surgery, Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People's Republic of China.
BMC Musculoskelet Disord. 2017 Aug 2;18(1):336. doi: 10.1186/s12891-017-1695-x.
The correlation between implant density and deformity correction has not yet led to a precise conclusion in adolescent idiopathic scoliosis (AIS). The aim of this study was to evaluate the effects of low density (LD) and high density (HD) pedicle screw instrumentation in terms of the clinical, radiological and Scoliosis Research Society (SRS)-22 outcomes in Lenke 1 AIS.
We retrospectively reviewed 62 consecutive Lenke 1 AIS patients who underwent posterior spinal arthrodesis using all-pedicle screw instrumentation with a minimum follow-up of 24 months. The implant density was defined as the number of screws per spinal level fused. Patients were then divided into two groups according to the average implant density for the entire study. The LD group (n = 28) had fewer than 1.61 screws per level, while the HD group (n = 34) had more than 1.61 screws per level. The radiographs were analysed preoperatively, postoperatively and at final follow-up. The perioperative and SRS-22 outcomes were also assessed. Independent sample t tests were used between the two groups.
Comparisons between the two groups showed no significant differences in the correction of the main thoracic curve and thoracic kyphosis, blood transfusion, hospital stay, and SRS-22 scores. Compared with the HD group, there was a decreased operating time (278.4 vs. 331.0 min, p = 0.004) and decreased blood loss (823.6 vs. 1010.9 ml, p = 0.048), pedicle screws needed (15.1 vs. 19.6, p < 0.001), and implant costs ($10,191.0 vs. $13,577.3, p = 0.003) in the LD group.
Both low density and high density pedicle screw instrumentation achieved satisfactory deformity correction in Lenke 1 AIS patients. However, the operating time and blood loss were reduced, and the implant costs were decreased with the use of low screw density constructs.
在青少年特发性脊柱侧凸（AIS）中，植入物密度与畸形矫正之间的相关性尚未得出确切结论。本研究的目的是评估低密度（LD）和高密度（HD）椎弓根螺钉内固定在Lenke 1型AIS患者的临床、影像学和脊柱侧凸研究学会（SRS）-22结果方面的效果。
我们回顾性分析了62例连续接受后路脊柱融合术并使用全椎弓根螺钉内固定的Lenke 1型AIS患者，最小随访时间为24个月。植入物密度定义为每个融合脊柱节段的螺钉数量。然后根据整个研究的平均植入物密度将患者分为两组。LD组（n = 28）每个节段的螺钉数量少于1.61枚，而HD组（n = 34）每个节段的螺钉数量多于1.61枚。对术前、术后和最终随访时的X线片进行分析。还评估了围手术期和SRS-22结果。两组之间采用独立样本t检验。
两组之间在主胸弯和胸椎后凸矫正、输血、住院时间和SRS-22评分方面无显著差异。与HD组相比，LD组的手术时间缩短（278.4对331.0分钟，p = 0.004）、失血量减少（823.6对1010.9毫升，p = 0.048）、所需椎弓根螺钉数量减少（15.1对19.6，p < 0.001）以及植入物成本降低（10,191.0对13,577.3美元，p = 0.003）。
低密度和高密度椎弓根螺钉内固定在Lenke 1型AIS患者中均实现了满意的畸形矫正。然而，使用低螺钉密度结构可减少手术时间和失血量，并降低植入物成本。
