Lastikka Markus, Oksanen Hanna, Helenius Linda, Pajulo Olli, Helenius Ilkka
Department of Paediatric Orthopaedic Surgery, University of Turku, Turku University Hospital, Turku, Finland.
Department of Paediatric Orthopaedic Surgery, University of Turku, Turku University Hospital, Turku, Finland.
World Neurosurg. 2019 Jul;127:e1020-e1025. doi: 10.1016/j.wneu.2019.04.028. Epub 2019 Apr 14.
Pedicle screw instrumentation is widely used for spinal deformity correction and fusion in adolescents for idiopathic scoliosis. The goal is to achieve and sustain good alignment in all 3 planes. We compared 2 different cobalt-chromium (CoCr) rod designs with different stiffnesses with regard to the restoration of coronal and sagittal balance in adolescents operated on for idiopathic scoliosis.
A prospective comparative study was made of 90 consecutive adolescents, mean age (standard deviation) 15.6 years (2.1 years), with idiopathic scoliosis who underwent posterior spinal fusion by the use of bilateral segmental pedicle screw instrumentation (PSI) with 6.0 Co-Cr rods. Fifty-four adolescents (43 girls) were operated on by the use of circular rods and 36 (27 girls) by the use of sagittal reinforced rods, with a 2-year follow-up.
Preoperative major coronal curves were similar and at 2 years: 11° (5.0) and 17° (7.2) with correction percentages of 78% (10) and 69% (12) in the circular and reinforced rod groups (P < 0.01). Thoracic kyphosis at 2 years measured 16° (7) and 21° (6) in the circular and reinforced rod groups (P < 0.01). The number of patients with hypokyphosis was lower in the reinforced rod group at 2 years (P = 0.02). In the reinforced rod group, there was a negative correlation between coronal correction and thoracic kyphosis (r = -0.52, P < 0.01).
Both circular and sagittal reinforced 6.0-mm CoCr rods provide adequate coronal correction for adolescents with idiopathic scoliosis. The use of sagittal reinforced rods provided better thoracic kyphosis restoration and a lower risk for postoperative hypokyphosis.
椎弓根螺钉内固定广泛应用于青少年特发性脊柱侧弯的畸形矫正和融合手术。目标是在三个平面上实现并维持良好的对线。我们比较了两种不同刚度的钴铬（CoCr）棒设计在青少年特发性脊柱侧弯手术中对冠状面和矢状面平衡恢复的效果。
对90例连续的青少年特发性脊柱侧弯患者进行前瞻性对照研究，平均年龄（标准差）15.6岁（2.1岁），他们接受了使用6.0 Co-Cr棒的双侧节段性椎弓根螺钉内固定（PSI）后路脊柱融合术。54例青少年（43名女孩）使用圆形棒进行手术，36例（27名女孩）使用矢状面加强棒进行手术，随访2年。
术前主冠状面曲线相似，术后2年时，圆形棒组和加强棒组分别为11°（5.0）和17°（7.2），矫正百分比分别为78%（10）和69%（12）（P < 0.01）。术后2年时，圆形棒组和加强棒组的胸椎后凸分别为16°（7）和21°（6）（P < 0.01）。加强棒组术后2年时后凸不足的患者数量较少（P = 0.02）。在加强棒组中，冠状面矫正与胸椎后凸之间存在负相关（r = -0.52，P < 0.01）。
圆形和矢状面加强的6.0毫米CoCr棒均能为青少年特发性脊柱侧弯患者提供足够的冠状面矫正。使用矢状面加强棒能更好地恢复胸椎后凸，且术后后凸不足的风险较低。
