Rosenfeld S, Kenney S, Rebich E
Department of Orthopedic Surgery, CHOC Children's Hospital, Orange, California, USA.
Department of Orthopedic Surgery, Riverside University Health System, Moreno Valley, California, USA.
J Child Orthop. 2019 Aug 1;13(4):393-398. doi: 10.1302/1863-2548.13.190059.
Multiple fixation techniques exist for treating progressive neuromuscular scoliosis including pedicle screws, sublaminar bands/wires, hooks or a combination of instruments. Most sublaminar band constructs are supplemented with pedicle screws, hooks and/or sublaminar wires particularly at the top of the construct. There are no studies to date that describe an all/predominant sublaminar band construct. The purpose of this study was to investigate the outcomes of a sublaminar polyester band construct to treat neuromuscular scoliosis.
A retrospective review was conducted of 32 cases of neuromuscular scoliosis treated with posterior spinal fusion using a sublaminar band construct between 2013 and 2016 by a single surgeon at a single centre. Preoperative, immediate postoperative and two-year follow-up radiographs and clinical records were reviewed. Sagittal, coronal and pelvic obliquity correction was measured. Blood loss, length of surgery and complications were recorded.
In all, 29 patients were included. Mean postoperative coronal plane correction was 57% (0% to 92%) and maintained at two-year follow-up. Mean sagittal balance was 2.3 cm (-2.5 to 6.4). Mean lumbar lordosis angle decreased by 7° (44° to 37°). Mean thoracic kyphosis angle increased by 9° (23° to 32°). Mean pelvic obliquity decreased by 50% (from 15° to 7°). There were four major complications (14%) and eight minor complications (21%). Mean blood loss was 1304 cc (250 cc to 2450 cc).
Sublaminar polyester band fixation constructs provide a viable option in correction of deformity in patients with neuromuscular scoliosis with comparable outcomes with what is reported with other constructs.
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治疗进行性神经肌肉型脊柱侧弯存在多种固定技术，包括椎弓根螺钉、椎板下带/钢丝、钩或多种器械联合使用。大多数椎板下带结构尤其在结构顶部会辅以椎弓根螺钉、钩和/或椎板下钢丝。迄今为止，尚无研究描述全/主要为椎板下带结构的情况。本研究的目的是探讨使用椎板下聚酯带结构治疗神经肌肉型脊柱侧弯的疗效。
对2013年至2016年期间由一名外科医生在单一中心采用椎板下带结构进行后路脊柱融合治疗的32例神经肌肉型脊柱侧弯病例进行回顾性研究。回顾术前、术后即刻及两年随访时的X线片和临床记录。测量矢状面、冠状面和骨盆倾斜度的矫正情况。记录失血量、手术时长和并发症情况。
共纳入29例患者。术后冠状面平均矫正率为57%（0%至92%），并在两年随访时得以维持。矢状面平均平衡为2.3厘米（-2.5至6.4）。腰椎前凸角平均减小7°（从44°至37°）。胸椎后凸角平均增加9°（从23°至32°）。骨盆倾斜度平均降低50%（从15°降至7°）。发生4例主要并发症（14%）和8例次要并发症（21%）。平均失血量为1304毫升（250毫升至2450毫升）。
椎板下聚酯带固定结构为矫正神经肌肉型脊柱侧弯患者的畸形提供了一种可行选择，其疗效与其他结构报道的相当。
V级
