Palmisani Matteo, Dema Eugenio, Cervellati Stefano, Palmisani Rosa
Scoliosis and Spinal Deformity Center, Hesperia Hospital, Modena, Italy.
Eur Spine J. 2018 Jun;27(Suppl 2):150-156. doi: 10.1007/s00586-018-5625-x. Epub 2018 May 17.
To compare the 2-year minimum postoperative results of posterior correction and spinal arthrodesis using translational correction with hybrid (sublaminar bands on concave side and pedicle screw) constructs versus correction with intermediate density pedicle screw-only constructs in the treatment of AIS (Lenke 1).
A total of 37 patients with AIS at single institutions who underwent posterior spinal arthrodesis pedicle screw with sublaminar bands at the apex (19 patients) (Group A) or pedicle screw-only (18) constructs (Group B) were selected and matched according to similar age at surgery 13.8 years (Group A) and 14.3 years (Group B), similar arthrodesis area 12.3 (Group A) and 11.5 (Group B), all curves Lenke type 1 with similar pre-op curve 54° (Group A) and 57° (Group B). Patients were evaluated pre-op, immediately post-op, and at min 2-year follow-up according to radiographic curve correction, operating time, intraoperative blood loss, and f.u. loss of correction.
The average curve correction was 65.6% in sublaminar group and 68% in pedicle screw group. At 2-year follow-up, loss of the major curve correction was 2% in sublaminar group compared to 3% in pedicle screw group. Postoperative coronal and sagittal balance was similar in both groups. Operating time averaged 200 min (Group A) and 180 min (Group B). Intraoperative blood loss was significantly different in both groups 700 ± 160 cc in sublaminar group and 630 ± 150 cc in pedicle screw group. There were no neurologic complications in both groups.
The two groups offer similar curve correction without neurologic complications in the surgical treatment of AIS (Lenke 1). The use of sublaminar bands on the apex (concave side) can be a valid fixation in the presence of hypoplastic pedicle, can reduce the thoracic hypokyphosis and derotate the vertebra but had more blood loss comparing to pedicle screws alone. These slides can be retrieved under Electronic Supplementary Material.
比较在治疗青少年特发性脊柱侧凸（Lenke 1型）时，采用平移矫正的混合结构（凹侧使用椎板下带和椎弓根螺钉）与仅使用中等密度椎弓根螺钉结构进行后路矫正和脊柱融合术后2年的最低结果。
选取单机构中37例接受后路脊柱融合术的青少年特发性脊柱侧凸患者，其中19例在顶点使用椎板下带和椎弓根螺钉（A组），18例仅使用椎弓根螺钉结构（B组）。根据手术时相似年龄（A组13.8岁，B组14.3岁）、相似融合面积（A组12.3，B组11.5）、所有曲线均为Lenke 1型且术前曲线相似（A组54°，B组57°）进行匹配。根据影像学曲线矫正、手术时间、术中失血和随访时矫正丢失情况，在术前、术后即刻和至少2年随访时对患者进行评估。
椎板下带组平均曲线矫正率为65.6%，椎弓根螺钉组为68%。在2年随访时，椎板下带组主曲线矫正丢失率为2%，椎弓根螺钉组为3%。两组术后冠状面和矢状面平衡相似。手术时间平均为200分钟（A组）和180分钟（B组）。两组术中失血有显著差异，椎板下带组为700±160毫升，椎弓根螺钉组为630±150毫升。两组均无神经并发症。
在青少年特发性脊柱侧凸（Lenke 1型）的手术治疗中，两组在曲线矫正方面相似且无神经并发症。在椎弓根发育不全的情况下，在顶点（凹侧）使用椎板下带可作为一种有效的固定方式，可减少胸椎后凸不足并使椎体旋转，但与单独使用椎弓根螺钉相比失血更多。这些幻灯片可在电子补充材料中获取。
