Ramchandran Subaraman, George Stephen, Asghar Jahangir, Shufflebarger Harry
Center for Spinal Disorders, Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 S.W. 62nd Ave, Miami, FL 33155, USA.
Center for Spinal Disorders, Department of Orthopedic Surgery, Nicklaus Children's Hospital, 3100 S.W. 62nd Ave, Miami, FL 33155, USA.
Spine Deform. 2019 Mar;7(2):286-292. doi: 10.1016/j.jspd.2018.08.003.
Single-center retrospective study.
To analyze two-year postoperative outcomes following spinopelvic fixation in pediatric patients using the anatomic trajectory (AT) portal for iliac screws.
Iliac fixation is crucial in situations requiring fusion to sacrum. Challenges include complex anatomy, pelvic deformation, severe deformity, and previous surgery. The PSIS portal requires significant dissection, rod connectors, and complex bends. The SAI portal requires navigating the screw across the SI joint to the ilium. The anatomic trajectory (AT), first reported in 2009, is between the PSIS and SAI portal, without prominence, connectors, or complex bends.
Fifty-four patients aged ≤18 years requiring instrumentation to the Ilium with minimum follow-up of two years (mean 44 months) were clinically and radiographically evaluated. Changes in coronal curve magnitude and pelvic obliquity were assessed using paired t test for patients with cerebral palsy. Spondylolisthesis reduction was assessed in patients with moderate- to high-grade spondylolisthesis (Meyerding grade 3 and 4).
A total of 108 iliac screws were inserted using AT portal in 54 patients. Twenty-eight neuromuscular and syndromic patients had an initial mean coronal curve of 85° corrected to 23° at two years (p < .001) and a pelvic obliquity of 22° corrected to 4° (p < .001). Twenty patients with moderate- to high-grade spondylolisthesis treated with reduction and interbody fixation improved significantly with respect to their slip angles (7° ± 14.7° to -7.9° ± 6.1°, p = .003). In the neuromuscular group, two surgical site infections occurred, two had implant fractures, and 12 had asymptomatic iliac screw loosening, none requiring revision. In the spondylolisthesis group, there were no neurologic complications and one had prominent screw requiring removal. Of 108 iliac screws, 2 rod connectors were employed.
Iliac screw insertion using the AT portal is a safe and effective method of pelvic fixation in pediatric patients with satisfactory radiographic correction and minimal complications.
Level 4.
单中心回顾性研究。
分析采用解剖轨迹（AT）入路置入髂骨螺钉的小儿患者术后两年的疗效。
在需要融合至骶骨的情况下，髂骨固定至关重要。挑战包括解剖结构复杂、骨盆变形、严重畸形以及既往手术史。梨状肌上孔入路需要广泛的解剖分离、棒连接件以及复杂的弯曲。骶髂关节前入路需要将螺钉穿过骶髂关节至髂骨。解剖轨迹（AT）于2009年首次报道，位于梨状肌上孔和骶髂关节前入路之间，无需显露、连接件或复杂的弯曲。
对54例年龄≤18岁、需要对髂骨进行器械固定且至少随访两年（平均44个月）的患者进行临床和影像学评估。对脑瘫患者，使用配对t检验评估冠状面曲线角度和骨盆倾斜度的变化。对中度至高度滑脱（迈耶丁分级3级和4级）患者评估滑脱复位情况。
54例患者共使用AT入路置入108枚髂骨螺钉。28例神经肌肉疾病和综合征患者最初的平均冠状面曲线为85°，两年时矫正至23°（p <.001），骨盆倾斜度从22°矫正至4°（p <.001）。20例接受复位和椎间融合固定治疗的中度至高度滑脱患者的滑脱角度显著改善（从7°±14.7°至-7.9°±6.1°，p =.003）。在神经肌肉疾病组，发生2例手术部位感染，2例植入物骨折，12例髂骨螺钉无症状松动，均无需翻修。在滑脱组，无神经并发症，1例螺钉突出需要取出。108枚髂骨螺钉中，使用了2个棒连接件。
采用AT入路置入髂骨螺钉是小儿患者骨盆固定的一种安全有效的方法，影像学矫正效果满意，并发症极少。
4级。
