Cobden Adem, Albayrak Akif, Camurcu Yalkin, Sofu Hakan, Tacal Temel, Kaygusuz Mehmet Akif
Department of Orthopaedics, Sivas Numune State Hospital, Sivas, Turkey.
Department of Spine Surgery, Baltalimani Bone Diseases Education And Research Hospital, İstanbul, Turkey.
Asian Spine J. 2017 Aug;11(4):513-519. doi: 10.4184/asj.2017.11.4.513. Epub 2017 Aug 7.
Retrospective study (level of evidence: level 3).
The purpose of this study was to evaluate the clinical and radiological results of the posterior-only approach with pedicle screws for the treatment of Scheuermann's kyphosis (SK).
The correction of SK with instrumentation can be performed using posterior-only or combined anterior-posterior procedures. With the use of all-pedicle screw constructs in spine surgery, the posterior-only approach has become a popular option for the definitive treatment of SK. In a nationwide study involving 2,796 patients, a trend toward posterior-only fusion with lower complication rates was reported.
We retrospectively reviewed the data of patients who underwent posterior-only correction for SK between January 2005 and May 2013. Patients with a definite diagnosis of SK who fulfilled the minimum follow-up criterion of 24 months were included. The thoracic kyphosis (T5-T12), lumbar lordosis (L1-S1), and thoracolumbar junction (T10-L2) angles were measured from preoperative, postoperative, and last control radiographs. Sagittal balance, thoracic length, thoracic diameter, Voutsinas index and the sacral slope, pelvic tilt, proximal junction kyphosis, and distal junction kyphosis angles were also measured.
Forty-five patients underwent surgery for the treatment of SK between 2005 and 2013. After applying the exclusion criteria, 20 patients (18 males and 2 females) with a mean age of 19 years were included. The mean thoracic kyphosis angle was 79.8 degrees preoperatively, 44.6 degrees postoperatively, and 44.9 degrees at the last control. There were statistically significant differences between preoperative and postoperative values in the thoracic kyphosis and lumbar lordosis angles, thoracic length, thoracic diameter, and Voutsinas index (<0.05).
The clinical and radiological results of the current study suggest that posterior-only fusion is an efficient technique for the treatment of SK.
回顾性研究（证据级别：3级）。
本研究旨在评估单纯后路椎弓根螺钉固定治疗休门氏后凸畸形（SK）的临床及影像学效果。
SK的器械矫正可采用单纯后路或前后路联合手术。随着脊柱手术中全椎弓根螺钉结构的应用，单纯后路手术已成为治疗SK的常用选择。在一项涉及2796例患者的全国性研究中，报道了单纯后路融合术并发症发生率较低的趋势。
我们回顾性分析了2005年1月至2013年5月期间接受单纯后路矫正SK的患者数据。纳入明确诊断为SK且满足至少24个月随访标准的患者。从术前、术后及末次随访的X线片测量胸椎后凸（T5-T12）、腰椎前凸（L1-S1）及胸腰段交界（T10-L2）角度。还测量矢状面平衡、胸椎长度、胸椎直径、Voutsinas指数以及骶骨倾斜度、骨盆倾斜度、近端交界区后凸和远端交界区后凸角度。
2005年至2013年期间，45例患者接受了SK治疗手术。应用排除标准后，纳入20例患者（18例男性，2例女性），平均年龄19岁。术前平均胸椎后凸角度为79.8度，术后为44.6度，末次随访时为44.9度。胸椎后凸和腰椎前凸角度、胸椎长度、胸椎直径及Voutsinas指数的术前与术后值之间存在统计学显著差异（<0.05）。
本研究的临床及影像学结果表明，单纯后路融合术是治疗SK的有效技术。
