Prudnikova Oksana G, Shchurova Elena N
Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, 6, M. Ulianova Street, Kurgan, Russian Federation, 640014.
Int Orthop. 2018 Feb;42(2):331-338. doi: 10.1007/s00264-017-3738-1. Epub 2017 Dec 21.
There is high risk of neurologic complications in one-stage management of severe rigid spinal deformities in adolescents. Therefore, gradual spine stretching variants are applied. One of them is the use of external transpedicular fixation.
Our aim was to retrospectively study the outcomes of gradual correction with an apparatus for external transpedicular fixation followed by internal fixation used for high-grade kyphoscoliosis in adolescents.
Twenty five patients were reviewed (mean age, 15.1 ± 0.4 years). Correction was performed in two stages: 1) gradual controlled correction with the apparatus for external transpedicular fixation; and 2) internal posterior transpedicular fixation. Rigid deformities in eight patients required discapophysectomy. Clinical and radiographic study of the outcomes was conducted immediately after treatment and at a mean long-term period of 3.8 ± 0.4 years. Pain was evaluated using the visual analogue scale (VAS, 10 points). The Oswestry questionnaire (ODI scale) was used for functional assessment.
Deformity correction with the external apparatus was 64.2 ± 4.6% in the main curve and 60.7 ± 3.7% in the compensatory one. It was 72.8 ± 4.1% and 66.2 ± 5.3% immediately after treatment and 70.8 ± 4.6% and 64.3 ± 4.2% at long term, respectively. Pain relieved by 33.2 ± 4.2% (p < 0.05) immediately after treatment and by 55.6 ± 2.8% (p < 0.05) at long term. ODI reduced by 30.2 ± 1.7% (p < 0.05) immediately after treatment and by 37.2 ± 1.6% (p < 0.05) at long term.
The apparatus for external transpedicular fixation provides gradual controlled correction for high-grade kyphoscoliosis in adolescents. Transition to internal fixation preserves the correction achieved, and correction is maintained at long term.
青少年严重僵硬脊柱畸形的一期治疗存在较高的神经并发症风险。因此，采用了逐步脊柱牵张的方法。其中一种是使用经椎弓根外固定。
我们的目的是回顾性研究采用经椎弓根外固定器械进行逐步矫正，随后进行内固定治疗青少年重度脊柱后凸畸形的疗效。
对25例患者进行了回顾性研究（平均年龄15.1±0.4岁）。矫正分两个阶段进行：1）使用经椎弓根外固定器械进行逐步控制性矫正；2）后路经椎弓根内固定。8例患者的僵硬畸形需要进行椎间盘椎体切除术。在治疗后立即以及平均3.8±0.4年的长期随访中对疗效进行了临床和影像学研究。使用视觉模拟量表（VAS，满分10分）评估疼痛。采用Oswestry问卷（ODI量表）进行功能评估。
主弯使用外固定器械矫正率为64.2±4.6%，代偿弯为60.7±3.7%。治疗后立即分别为72.8±4.1%和66.2±5.3%，长期分别为70.8±4.6%和64.3±4.2%。治疗后疼痛立即缓解33.2±4.2%（p<0.05），长期缓解55.6±2.8%（p<0.05）。ODI在治疗后立即降低30.2±1.7%（p<0.05），长期降低37.2±1.6%（p<0.05）。
经椎弓根外固定器械可为青少年重度脊柱后凸畸形提供逐步控制性矫正。向内固定的过渡保留了已取得的矫正效果，且长期维持了矫正。
