Lin Yang, Chen Wenjian, Chen Anmin, Li Feng, Xiong Wei
Department of Orthopedics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Department of Orthopedics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
World Neurosurg. 2018 Mar;111:e830-e844. doi: 10.1016/j.wneu.2017.12.161. Epub 2018 Jan 5.
To compare the clinical efficacy of anterior and posterior approaches for selective thoracic fusion (STF) and selective thoracolumbar/lumbar fusion (SLF) in treating adolescent idiopathic scoliosis (AIS).
English-language literature on selective fusion treatment of AIS published before September 2016 was retrieved from the PubMed, Embase, Cochrane, and Google Scholar databases. Studies were manually selected for inclusion based on preset criteria. Relevant radiologic data were extracted, and a systematic review and meta-analysis were performed.
Thirty-five eligible studies were included. The Cobb angles of the main thoracic and minor thoracolumbar/lumbar curves at the final follow-up were significantly and similarly corrected in the anterior and posterior STF groups. Anterior but not posterior STF was effective in correcting thoracic and thoracolumbar junctional hypokyphosis and in promoting sagittal balance, as determined by the relative position of the C7 plumb line. Similarly, in both the anterior and posterior SLF groups, the final Cobb angles of main thoracolumbar/lumbar and minor thoracic curves were significantly reduced compared with angles before surgery (P < 0.05). In contrast, posterior but not anterior SLF was effective in correcting lumbar hypolordosis and thoracic hypokyphosis. Both anterior and posterior SLF promoted coronal balance, with no effects on sagittal balance.
Both anterior and posterior approaches are effective for treatment of AIS. Anterior is more effective than posterior STF in correcting thoracic and thoracolumbar junctional hypokyphosis and in restoring sagittal balance. Posterior is more effective than anterior SLF in correcting lumbar hypolordosis and thoracic hypokyphosis and in restoring the sagittal curvature.
比较前路和后路选择性胸椎融合术（STF）及选择性胸腰段/腰椎融合术（SLF）治疗青少年特发性脊柱侧凸（AIS）的临床疗效。
从PubMed、Embase、Cochrane和谷歌学术数据库中检索2016年9月之前发表的关于AIS选择性融合治疗的英文文献。根据预设标准手动筛选纳入研究。提取相关放射学数据，并进行系统评价和荟萃分析。
纳入35项符合条件的研究。在最终随访时，前路和后路STF组的主胸弯和次胸腰段/腰弯的Cobb角均得到显著且相似的矫正。根据C7铅垂线的相对位置确定，前路而非后路STF在矫正胸段和胸腰段交界性后凸不足以及促进矢状面平衡方面有效。同样，在前路和后路SLF组中，与术前角度相比，主胸腰段/腰弯和次胸弯的最终Cobb角均显著减小（P < 0.05）。相比之下，后路而非前路SLF在矫正腰椎前凸不足和胸椎后凸不足方面有效。前路和后路SLF均促进了冠状面平衡，对矢状面平衡无影响。
前路和后路手术治疗AIS均有效。前路在矫正胸段和胸腰段交界性后凸不足以及恢复矢状面平衡方面比后路STF更有效。后路在矫正腰椎前凸不足和胸椎后凸不足以及恢复矢状面曲度方面比前路SLF更有效。
