Si Gao, Li Tong, Wang Yu, Liu Xiaoguang, Li Chunde, Yu Miao
Department of Orthopaedic Surgery, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, People's Republic of China.
Department of Orthopaedic Surgery, Peking University First Hospital, Beijing, People's Republic of China.
Eur Spine J. 2021 Mar;30(3):706-713. doi: 10.1007/s00586-020-06546-w. Epub 2020 Jul 27.
To compare the safety and efficacy of posterior minimally invasive surgery (MIS) to standard posterior spinal fusion (PSF) surgery for Lenke Type 1-4 adolescent idiopathic scoliosis (AIS).
This multicenter retrospective study enrolled 112 patients with Lenke Type 1-4 AIS who treated with MIS (n = 64) or PSF (n = 48) between March 2007 and January 2015. Coronal and sagittal parameters were evaluated before surgery, immediately after surgery, and at the last follow-up. Operative time, level of fusion, intraoperative blood loss, blood transfusion, and intraoperative radiation exposure were recorded. 22-item Scoliosis Research Society questionnaire (SRS-22) was applied for assessment of life quality. The accuracy of pedicle screw placement was assessed according to postoperative computed tomography images, and the complications were collected in follow-up period.
The baseline characteristics of 2 groups were matched. There was no significant difference between 2 groups in terms of radiographic parameters immediately after surgery and at the last follow-up. The MIS group had significantly longer operative time, more level of fusion, less intraoperative blood loss, and lower blood transfusion rate (p < 0.001). The evaluation of pain using SRS-22 showed significantly lower score in MIS group (p < 0.05). No significant difference was found between 2 groups in terms of accuracy of pedicle screw placement and complications.
Posterior MIS is a safe and effective alternative to standard open approach for Lenke Type 1-4 AIS patients with curves < 70° and reasonable flexibility. Mid-term results showed MIS had the advantages of less blood loss and pain with more fusion segments.
比较后路微创手术（MIS）与标准后路脊柱融合术（PSF）治疗Lenke 1-4型青少年特发性脊柱侧凸（AIS）的安全性和有效性。
这项多中心回顾性研究纳入了112例Lenke 1-4型AIS患者，这些患者在2007年3月至2015年1月期间接受了MIS治疗（n = 64）或PSF治疗（n = 48）。在手术前、手术后即刻和最后一次随访时评估冠状面和矢状面参数。记录手术时间、融合节段、术中失血、输血情况和术中辐射暴露。应用22项脊柱侧凸研究学会问卷（SRS-22）评估生活质量。根据术后计算机断层扫描图像评估椎弓根螺钉置入的准确性，并在随访期间收集并发症。
两组的基线特征相匹配。两组在术后即刻和最后一次随访时的影像学参数方面无显著差异。MIS组的手术时间明显更长，融合节段更多，术中失血更少，输血率更低（p < 0.001）。使用SRS-22评估疼痛情况显示，MIS组的评分明显更低（p < 0.05）。两组在椎弓根螺钉置入准确性和并发症方面无显著差异。
对于Lenke 1-4型、侧弯< 70°且柔韧性合理的AIS患者而言，后路MIS是标准开放手术的一种安全有效的替代方法。中期结果显示，MIS具有失血少、疼痛轻且融合节段更多的优点。
