Lonner Baron S, Haber Lawrence, Toombs Courtney, Parent Stefan, Shah Suken A, Lenke Lawrence, Sucato Daniel, Clements David, Newton Peter O
Department of Orthopaedic Surgery, Mount Sinai Hospital.
Ochsner Hospital for Children, New Orleans, LA.
J Pediatr Orthop. 2020 Mar;40(3):e161-e165. doi: 10.1097/BPO.0000000000001433.
A retrospective analysis of a prospectively collected database was performed.
The purpose of this study is to compare 3-dimensional correction associated with the anterior release (AR) and contemporary posterior instrumentation versus posterior-only surgery.
The role of AR as a tool in the treatment of adolescent idiopathic scoliosis (AIS) has seen a decline with the popularization of thoracic pedicle screw instrumentation.
Five surgeons were queried for all surgical thoracic AIS cases from 2003 to 2010 treated with thoracoscopic AR/fusion and contemporary posterior instrumentation and fusion and thoracic pedicle screw instrumentation (>80% screws) with 2-year follow-up. These cases were then matched with posterior spinal fusion only cases from a multicenter prospective database. The 2 groups were matched on the basis of major curve magnitude within 5 degrees, T5-T12 kyphosis within 9 degrees, and angle of trunk rotation within 9 degrees. Radiographic and clinical parameters were compared for the 2 groups. Continuous variables were analyzed with analysis of variance and categorical dependent variables with the χ test.
A total of 47 cases of AR were matched to 47 (1:1 match) posterior spinal fusion cases. Preoperative parameters were similar between groups (P>0.05). Postoperatively, AR cases had a lower major curve (20 vs. 25 degrees, P=0.034; 72% vs. 66% correction, P=0.037). T5-T12 kyphosis was greater in the AR cases (26 vs. 20 degrees; P=0.005). The angle of trunk rotation was similar for the groups. Anchor density was lower in the AR group (1.6 vs. 1.9; P<0.0001). There were 3 complications associated with the AR: 1 pneumothorax and 2 conversions to minithoracotomies for failure to maintain single lung ventilation.
AR improves coronal and sagittal plane correction in contemporary AIS surgery with a satisfactory complication profile with less pedicle screw density required for clinically similar corrections. A further prospective study on the benefits of AR may help define specific indications.
对前瞻性收集的数据库进行回顾性分析。
本研究旨在比较前路松解（AR）联合现代后路内固定与单纯后路手术在三维矫正方面的效果。
随着胸椎椎弓根螺钉内固定技术的普及，AR作为治疗青少年特发性脊柱侧凸（AIS）的一种工具的作用已有所下降。
向5位外科医生询问了2003年至2010年期间接受胸腔镜AR/融合术、现代后路内固定与融合术以及胸椎椎弓根螺钉内固定术（螺钉使用率>80%）且有2年随访的所有手术治疗的胸椎AIS病例。然后将这些病例与来自多中心前瞻性数据库的单纯后路脊柱融合病例进行匹配。两组根据主弯角度在5度以内、T5 - T12后凸在9度以内以及躯干旋转角度在9度以内进行匹配。比较两组的影像学和临床参数。连续变量采用方差分析，分类因变量采用χ检验。
共47例AR病例与47例（1:1匹配）后路脊柱融合病例相匹配。两组术前参数相似（P>0.05）。术后，AR组病例的主弯角度更小（20度对25度，P = 0.034；矫正率72%对66%，P = 0.037）。AR组的T5 - T12后凸更大（26度对20度；P = 0.005）。两组的躯干旋转角度相似。AR组的锚定密度更低（1.6对1.9；P<0.0001）。AR组有3例并发症：1例气胸和2例因无法维持单肺通气而转为小切口开胸手术。
在现代AIS手术中，AR可改善冠状面和矢状面的矫正效果，并发症情况令人满意，在临床相似矫正中所需的椎弓根螺钉密度更低。关于AR益处的进一步前瞻性研究可能有助于确定具体适应症。
