Paediatric Orthopaedics, Timone Enfants, Aix Marseille University, Marseille, France.
Spine Research Laboratory, Hospital for Special Surgery, New York, New York, USA.
Bone Joint J. 2020 Mar;102-B(3):376-382. doi: 10.1302/0301-620X.102B3.BJJ-2019-0993.R1.
To compare the rates of sagittal and coronal correction for all-pedicle screw instrumentation and hybrid instrumentation using sublaminar bands in the treatment of thoracic adolescent idiopathic scoliosis (AIS).
We retrospectively reviewed the medical records of 124 patients who had undergone surgery in two centres for the correction of Lenke 1 or 2 AIS. Radiological evaluation was carried out preoperatively, in the early postoperative phase, and at two-year follow-up. Parameters measured included coronal Cobb angles and thoracic kyphosis. Postoperative alignment was compared after matching the cohorts by preoperative coronal Cobb angle, thoracic kyphosis, lumbar lordosis, and pelvic incidence.
A total of 179 patients were available for analysis. After matching, 124 patients remained (62 in each cohort). Restoration of thoracic kyphosis was significantly better in the sublaminar band group than in the pedicle screw group (from 23.7° to 27.5° to 34.0° versus 23.9° to 18.7° to 21.5°; all p < 0.001). When the preoperative thoracic kyphosis was less than 20°, sublaminar bands achieved a normal postoperative thoracic kyphosis, whereas pedicle screws did not. In the coronal plane, pedicle screws resulted in a significantly better correction than sublaminar bands at final follow-up (73.0% versus 59.7%; p < 0.001).
This is the first study to compare sublaminar bands and pedicle screws for the correction of a thoracic AIS. We have shown that pedicle screws give a good coronal correction which is maintained at two-year follow-up. Conversely, sublaminar bands restore the thoracic kyphosis better while pedicle screws are associated with a flattening of the thoracic spine. In patients with preoperative hypokyphosis, sublaminar bands should be used to restore a proper sagittal profile. Cite this article: 2020;102-B(3):376-382.
比较全椎弓根螺钉固定融合和使用皮下条带的杂交技术治疗青少年特发性脊柱侧凸（AIS）的矢状面和冠状面矫正率。
我们回顾性分析了在两个中心接受手术治疗 Lenke 1 或 2 型 AIS 的 124 名患者的病历。术前、术后早期和两年随访时进行影像学评估。测量的参数包括冠状 Cobb 角和胸椎后凸。通过匹配术前冠状 Cobb 角、胸椎后凸、腰椎前凸和骨盆入射角，对术后的对线进行比较。
共 179 例患者可供分析。匹配后，124 例患者仍纳入研究（每组 62 例）。皮下条带组的胸椎后凸恢复明显优于椎弓根螺钉组（从 23.7°增加到 27.5°，再增加到 34.0°，而椎弓根螺钉组从 23.9°减少到 18.7°，再减少到 21.5°；均 P<0.001）。当术前胸椎后凸小于 20°时，皮下条带可以获得正常的术后胸椎后凸，而椎弓根螺钉则不行。在冠状面上，最终随访时椎弓根螺钉的矫正效果明显优于皮下条带（73.0%比 59.7%；P<0.001）。
这是第一项比较皮下条带和椎弓根螺钉治疗青少年特发性胸椎侧凸的研究。我们已经表明，椎弓根螺钉可以提供良好的冠状面矫正，并且在两年随访时得到维持。相反，皮下条带可以更好地恢复胸椎后凸，而椎弓根螺钉则与胸椎变平有关。对于术前存在胸椎后凸不足的患者，应使用皮下条带来恢复适当的矢状面形态。
2020;102-B(3):376-382.
