Allia Jérémy, Clément Jean-Luc, Rampal Virginie, Leloutre Béatrice, Rosello Olivier, Solla Federico
Pediatric Orthopaedic Surgery.
Pediatric Radiology, Lenval University Children Hospital, Nice, France.
Clin Spine Surg. 2018 Apr;31(3):E209-E215. doi: 10.1097/BSD.0000000000000621.
Monocentric study comparing results of simultaneous translation on 2 rods (ST2R) with derotation connectors (prospective series) or without derotation connectors (retrospective series) in Adolescent Idiopathic Scoliosis (AIS) surgery.
The objective of this study was to assess if derotation connectors influence axial, coronal, and sagittal results in AIS surgery.
Conventional reduction techniques remain limited in their ability to reduce axial torsion. Direct vertebral derotation technique accomplishes partial axial derotation but decreases thoracic kyphosis.
Monocentric study including AIS surgeries performed using ST2R technique with derotation connectors (group D+, n=44) or without derotation connectors (group D-, n=24). The axial intervertebral rotation was measured between apical and neutral vertebra on pre and postoperative computed tomography scan. T test was used to compare mean values. ANCOVA analyzed the influence of connectors and covariates on the primary outcome, which was the difference between preoperative and postoperative intervertebral rotation.
The mean axial torsion gain in the D+ group was 23% (+3.84 degrees, 95% confidence interval, +1.95/+5.73). In the D- group, mean axial torsion increase of 4% (-0.42 degrees, 95% confidence interval, -1.19/+2.03). The result was significantly different between the 2 groups (P=0.005). The coronal correction of the main curve angle was 80% in the D+ group and 64% in the D- group (P=0.004). Kyphosis correction was similar between the 2 groups (P=0.3) with significant increase of thoracic kyphosis in the whole series (P=0.02) and no patients with postoperative hypokyphosis <10 degrees. Multivariate analysis confirmed the influence of derotation connectors on both axial and coronal correction (P<0.05).
The use of derotation connectors in the surgical treatment of AIS significantly improved axial and coronal correction compared to nonuse of connectors without compromising the sagittal plane.
一项单中心研究，比较青少年特发性脊柱侧凸（AIS）手术中使用带去旋转连接器的双棒同步平移技术（ST2R）（前瞻性队列）和不带去旋转连接器（回顾性队列）的结果。
本研究的目的是评估去旋转连接器是否会影响AIS手术中的轴向、冠状面和矢状面结果。
传统的矫正技术在减少轴向扭转方面的能力仍然有限。直接椎体去旋转技术可实现部分轴向去旋转，但会减少胸椎后凸。
一项单中心研究，纳入使用带去旋转连接器的ST2R技术进行的AIS手术（D+组，n = 44）或不带去旋转连接器的手术（D-组，n = 24）。在术前和术后计算机断层扫描上测量顶椎和中立椎之间的轴向椎间旋转。采用t检验比较平均值。协方差分析分析连接器和协变量对主要结局的影响，主要结局是术前和术后椎间旋转的差异。
D+组的平均轴向扭转增益为23%（+3.84度，95%置信区间，+1.95/+5.73）。在D-组中，平均轴向扭转增加4%（-0.42度，95%置信区间，-1.19/+2.03）。两组结果差异显著（P = 0.005）。D+组主弯角度的冠状面矫正为80%，D-组为64%（P = 0.004）。两组之间的后凸矫正相似（P = 0.3），整个队列中胸椎后凸显著增加（P = 0.02），且无术后后凸小于10度的患者。多变量分析证实去旋转连接器对轴向和冠状面矫正均有影响（P < 0.05）。
与不使用连接器相比，在AIS手术治疗中使用去旋转连接器可显著改善轴向和冠状面矫正，且不影响矢状面。
