差异化杆形矫正对于改善青少年特发性脊柱侧凸患者的脊柱旋转至关重要：术中 CT 评估胸弯。

Differential Rod Contouring is Essential for Improving Vertebral Rotation in Patients With Adolescent Idiopathic Scoliosis: Thoracic Curves Assessed With Intraoperative CT.

机构信息

Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan.

Department of Orthopaedic Surgery, Rady Children's Hospital and Health Center, San Diego, CA.

出版信息

Spine (Phila Pa 1976). 2018 May 15;43(10):E585-E591. doi: 10.1097/BRS.0000000000002428.

DOI:10.1097/BRS.0000000000002428

PMID:28953709

Abstract

STUDY DESIGN

A case series.

OBJECTIVE

We investigated the contributions of rod contouring and differential rod contouring (DRC) to the reduction of apical axial vertebral body rotation in patients with adolescent idiopathic scoliosis (AIS).

SUMMARY OF BACKGROUND DATA

DRC is used for posterior spinal correction and fusion. The contribution of DRC to vertebral body derotation is unclear.

METHODS

We analyzed the results of intraoperative computed tomography (CT) in 40 consecutive AIS patients with thoracic curves (Lenke type I or II, 35; type III or IV, 5). Rod contour before initial rod rotation was analyzed by x-ray. Periapical rod contour between concave and convex rod rotation (RR) were analyzed by cone-beam CT imaging. To analyze the reduction of vertebral body rotation with DRC, intraoperative cone-beam CT scans of the three apical vertebrae of the major curve of the scoliosis (120 vertebrae) were taken post-concave RR and post-convex DRC in all patients. The angle of vertebral body rotation was measured. In addition, the contribution of rod contouring to apical vertebral body derotation was analyzed. Rib hump indices (RHi) were measured by pre- and postoperative CT.

RESULTS

The mean vertebral body rotation angles post-concave RR and post-convex DRC were 15.3° and 9.3°, respectively, for a mean reduction of vertebral rotation in convex DRC after concave RR of 6.0° for thoracic curves (P < 0.001). The RHi was significantly improved by DRC (P < 0.05). Improved apical vertebral rotation was significantly correlated with the difference of apical rod curvature between concave and convex. Vertebral derotation was significantly higher in curves with > 10° difference between concave and convex rod curvature than differences < 10°.

CONCLUSION

DRC contributed substantially to axial derotation and reducing rib hump in thoracic scoliosis. The degree of apical rod curvature correlated with the degree of apical vertebral derotation.

LEVEL OF EVIDENCE

摘要

研究设计

病例系列研究。

目的

我们研究了杆形轮廓和差异杆形轮廓（DRC）在减少青少年特发性脊柱侧凸（AIS）患者的顶椎轴向椎体旋转中的作用。

背景资料概要

DRC 用于脊柱后向矫正和融合。DRC 对椎体复旋的作用尚不清楚。

方法

我们分析了 40 例连续的胸弯 AIS 患者（Lenke 型 I 或 II 型 35 例，III 或 IV 型 5 例）术中计算机断层扫描（CT）的结果。通过 X 射线分析初始杆旋转前的杆轮廓。通过锥形束 CT 成像分析凹侧和凸侧杆旋转（RR）之间的近侧杆轮廓。为了分析 DRC 对椎体旋转的减少，我们对所有患者的脊柱侧凸主弯的三个顶椎（120 个椎体）进行了术后凹侧 RR 和术后凸侧 DRC 的术中锥形束 CT 扫描。测量椎体旋转角度。此外，还分析了杆形轮廓对顶椎椎体复旋的影响。通过术前和术后 CT 测量肋骨隆凸指数（RHi）。

结果

凹侧 RR 和凸侧 DRC 后椎体旋转角度的平均值分别为 15.3°和 9.3°，胸弯凹侧 RR 后凸侧 DRC 平均椎体旋转减少 6.0°（P < 0.001）。DRC 显著改善了 RHi（P < 0.05）。顶椎椎体旋转的改善与凹侧和凸侧杆曲率之间的差异显著相关。凹侧和凸侧杆曲率之间的差值大于 10°的曲线的椎体复旋显著高于差值小于 10°的曲线。