三种脑瘫儿童脊柱侧凸骨盆固定方法：5 年随访结果比较。
Three Methods of Pelvic Fixation for Scoliosis in Children With Cerebral Palsy: Differences at 5-year Follow-Up.
机构信息
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA.
出版信息
Spine (Phila Pa 1976). 2019 Jan 1;44(1):E19-E25. doi: 10.1097/BRS.0000000000002761.
STUDY DESIGN
A retrospective review.
OBJECTIVE
The aim of this study was to assess correction of pelvic obliquity in children with cerebral palsy (CP) scoliosis postoperatively and 5 years after posterior spinal fusion with pelvic fixation using unit rods, sacral-alar-iliac (SAI) screws, or iliac screws.
SUMMARY OF BACKGROUND DATA
There are multiple options for pelvic fixation in children with scoliosis secondary to CP. The long-term differences in outcomes between these fixation methods are still unclear.
METHODS
A multicenter review identified records of 70 children with CP who underwent posterior spinal fusion for scoliosis using unit rods (n = 9), SAI screws (n = 19), or iliac screws (n = 42). Patients younger than 18 years with 5-year follow-up were included. Pelvic obliquity and major coronal curve measurements were compared using preoperative, (first erect) postoperative, and 5-year follow-up radiographs. Implant-related complications were noted. Alpha = 0.05.
RESULTS
For all groups, there was a significant difference between preoperative and postoperative pelvic obliquity that was maintained at 5 years. At 5-year follow-up, pelvic obliquity was significantly higher in the IS group (12°) compared with the unit rod group (4°, P = 0.001) and SAI screw group (6°) (P = 0.006). Implant-related complications were as follows: unit rod group, one patient (reoperation); SAI screw group, none; iliac screw group, six patients, including three cases of loss of connection between the rod and the iliac screw, two prominent screws, and one loose screw.
CONCLUSION
Correction of pelvic obliquity for children with CP-related scoliosis was achieved postoperatively using unit rods, SAI screws, and iliac screws. Implant-related complications and reoperations were most common in the iliac screw group. At 5-year follow-up, the iliac screw group had loss of major curve correction and less correction of pelvic obliquity than the unit rod and SAI screw groups.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
本研究旨在评估使用单位棒、骶髂-肋-髂（SAI）螺钉或髂螺钉进行后路脊柱融合术后 5 年治疗脑瘫（CP）脊柱侧凸儿童的骨盆倾斜矫正情况。
背景资料概要
CP 继发脊柱侧凸的儿童有多种骨盆固定方法可供选择。这些固定方法的长期结果差异仍不清楚。
方法
多中心回顾性研究确定了 70 例接受后路脊柱融合术治疗脊柱侧凸的 CP 患儿的记录，其中使用单位棒（n=9）、SAI 螺钉（n=19）或髂螺钉（n=42）。纳入年龄小于 18 岁且有 5 年随访的患者。使用术前、（首次直立）术后和 5 年随访的 X 线片比较骨盆倾斜度和主要冠状面曲线测量值。记录与植入物相关的并发症。α=0.05。
结果
对于所有组，术前和术后骨盆倾斜度均有显著差异，且在 5 年时仍保持不变。在 5 年随访时，与单位棒组（4°）和 SAI 螺钉组（6°）相比，髂螺钉组（12°）的骨盆倾斜度显著更高（P=0.001 和 P=0.006）。与植入物相关的并发症如下：单位棒组，1 例患者（再次手术）；SAI 螺钉组，无；髂螺钉组，6 例，包括 3 例棒与髂螺钉连接丢失，2 例突出螺钉和 1 例松动螺钉。
结论
CP 相关脊柱侧凸儿童使用单位棒、SAI 螺钉和髂螺钉进行后路脊柱融合术后可矫正骨盆倾斜。髂螺钉组最常见的并发症是植入物相关并发症和再次手术。在 5 年随访时，髂螺钉组的主要曲线矫正丢失和骨盆倾斜矫正减少比单位棒和 SAI 螺钉组更明显。
证据水平
3 级。
Zotero 插件