Agarwal Aakash, Aker Loai, Ahmad Alaaeldin Azmi
University of Toledo, Toledo, OH, USA.
Annajah Medical School, Nablus, Palestine.
Global Spine J. 2020 Jun;10(4):438-442. doi: 10.1177/2192568219859836. Epub 2019 Jun 23.
A retrospective study.
To determine if active remodulation in the apex of the curve is possible in scoliosis and kyphoscoliosis patients, using a modified SHILLA; active apex correction (APC) technique for guided growth.
Twenty patients with either scoliosis or kyphoscoliosis underwent a modified SHILLA approach, where instead of apical fusion, APC was applied. In this modified technique, the most wedged vertebra was selected followed by insertion of pedicle screws in the convex side of the vertebrae above and below the wedged one. The convex and concave heights of the wedged and control vertebrae were recorded at the time of the surgery and at follow-up duration, both using computed tomography.
The wedged vertebra demonstrated in average a 17% ( = .00014) increase in the proportion of concave to convex heights ratio, whereas the control vertebra did not show any relative change in the wedged vertebra heights at the follow-ups.
APC, instead of apical fusion in SHILLA remodulates the apex vertebra, which may in turn help mitigate loss of correction on long term due to crankshafting and adding-on.
一项回顾性研究。
使用改良的SHILLA主动顶点矫正（APC）技术进行引导生长，以确定脊柱侧凸和脊柱后凸患者的脊柱曲线顶点是否可能进行主动重塑。
20例脊柱侧凸或脊柱后凸患者接受改良的SHILLA手术，采用APC而非顶点融合术。在这种改良技术中，选择最楔形的椎体，然后在楔形椎体上方和下方椎体的凸侧插入椎弓根螺钉。使用计算机断层扫描在手术时和随访期间记录楔形椎体和对照椎体的凸侧和凹侧高度。
楔形椎体的凹侧与凸侧高度比平均增加了17%（ = .00014），而对照椎体在随访时楔形椎体高度未显示任何相对变化。
在SHILLA手术中，APC而非顶点融合可重塑顶点椎体，这反过来可能有助于减轻长期因曲轴效应和附加现象导致的矫正丢失。
