Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Department of Spine Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Spine (Phila Pa 1976). 2018 Jul 1;43(13):E758-E765. doi: 10.1097/BRS.0000000000002489.
A retrospective matched-cohort comparative study.
The aim of this study was to compare the surgical results after the use of duet screw based satellite rods and bilateral satellite rods (S-RC) versus a standard two-rod construct (2-RC) across osteotomy sites in a matched cohort with Scheuermann kyphosis (SK).
Multiple Ponte osteotomies are frequently employed to correct SK via a posterior-only approach, with a 2-RC across the osteotomy sites. Whereas, correction rate and junction problems remain as the major concerns.
This study reviewed a consecutive series of patients with SK who had undergone posterior-only correction with multilevel Ponte osteotomy between 2009 and 2014 and had been followed over 24 months. Twenty-two patients receiving placement with an S-RC with the use of duet screws were identified and closely matched with 22 patients with a 2-RC in terms of age, apex, and magnitude of kyphosis. Comparisons were made with regards to deformity magnitude, correction results, complications, and clinical outcomes between the two groups.
No significant difference was found between groups in preoperative patient's factors (age, gender, apex, magnitude of kyphosis, and SRS-22 scores) and surgical factors (blood loss, operation time, osteotomy levels, and fused levels). Compared with the 2-RC group, the S-RC group had higher correction rate (55.4% ± 7.5% vs. 46.2% ± 5.1%, P < 0.001), less correction loss (1.0 ± 0.8° vs. 2.4 ± 1.4°, P < 0.001) during the follow-up, and higher improvement of back pain as well (P < 0.05). None were detected with pseudarthrosis or implant failure in either group, but proximal junctional kyphosis was less frequently seen in S-RC group (1 of 22) than 2-RC group (7 of 22) (P < 0.05).
As a safe method, use of S-RC is effective in providing increased kyphotic correction across multiple Ponte osteotomy levels, and improving patient-reported outcomes of management satisfaction and back pain. The biomechanical benefits of stress dispersion, coupled with increased stability and weight bearing ability, make it a powerful technique preventing correction loss and proximal junctional kyphosis.
回顾性匹配队列比较研究。
本研究旨在比较使用双螺钉卫星棒（Duet screw based satellite rods）与双侧卫星棒（Bilateral satellite rods，S-RC）治疗Scheuermann 后凸畸形（Scheuermann kyphosis，SK）患者后路融合截骨术后的手术结果，这些患者在匹配队列中根据截骨部位分为单棒组（S-RC）和双棒组（2-RC）。
为了通过后路矫形治疗 SK，常采用多节段 Ponte 截骨术，同时在截骨部位使用 2-RC。然而，矫形率和交界区问题仍然是主要关注点。
本研究回顾性分析了 2009 年至 2014 年间接受后路多节段 Ponte 截骨术治疗的 SK 患者，术后随访时间超过 24 个月。共 22 例患者接受 S-RC 置棒治疗，并使用 Duet 螺钉固定，通过年龄、顶椎、后凸程度等因素进行匹配，选择 22 例接受 2-RC 治疗的患者作为对照组。比较两组患者的畸形程度、矫正效果、并发症和临床结果。
两组患者的术前患者因素（年龄、性别、顶椎、后凸程度和 SRS-22 评分）和手术因素（出血量、手术时间、截骨节段和融合节段）无显著差异。与 2-RC 组相比，S-RC 组的矫正率更高（55.4%±7.5%比 46.2%±5.1%，P＜0.001），矫正丢失更少（1.0°±0.8°比 2.4°±1.4°，P＜0.001），随访期间腰背疼痛改善更明显（P＜0.05）。两组均未发生假关节或内固定失败，但 S-RC 组近端交界区后凸发生率（1/22）低于 2-RC 组（7/22）（P＜0.05）。
S-RC 是一种安全有效的方法，可在多节段 Ponte 截骨部位提供更好的后凸矫正效果，并改善患者的管理满意度和腰背疼痛报告结果。应力分散的生物力学优势，结合增加的稳定性和承重能力，使其成为一种预防矫正丢失和近端交界区后凸的有效技术。
3 级
