Charles Yann P, Marchand Pierre-Luc, Tuzin Nicolas, Steib Jean-Paul
Spine Surgery.
Public Health, University Hospital of Strasbourg, Federation of Translational Medicine (FMTS), University of Strasbourg, Strasbourg, France.
Clin Spine Surg. 2021 Jul 1;34(6):E354-E363. doi: 10.1097/BSD.0000000000001171.
This was a retrospective observational study.
The aim of this study was to evaluate kyphosis and lordosis distribution, inflexion points, and the relationship with proximal junctional kyphosis (PJK) comparing hybrid instrumentation (in situ contouring, derotation) versus screw instrumentation (thoracic cantilever reduction, lumbar in situ contouring, and derotation).
The combination of reduction techniques aims at restoring the levels of lumbar apex and thoracolumbar inflexion point according to Roussouly alignment types. This approach could minimize the PJK risk after adolescent idiopathic scoliosis (AIS) surgery.
The study assessed coronal curve correction, thoracolumbar and spinopelvic sagittal parameters in 86 skeletally mature adolescents and young adults 2.2 years after AIS correction, comparing a hybrid group (HG, n=34) to a screw group (SG, n=52). Segmental kyphosis and lordosis distribution, number of vertebrae included in curves, thoracic and lumbar apex, thoracolumbar inflexion point and Roussouly types were modeled using KEOPS software.
Global coronal and sagittal correction were similar in both groups. In the SG, lumbar lordosis (LL) decreased from 61.1 to 53.9 degrees (P<0.0001) and matched with pelvic incidence (r=0.69), whereas LL did not change in the HG. Postoperatively, the thoracolumbar inflexion point migrated cranially, resulting in a longer LL in both groups. Postoperative thoracolumbar inflexion point (P<0.0001) and the lumbar apex (P=0.0274) were more caudal in the SG compared with the HG. The PJK rate was 14.7% in the HG and 7.7% in the SG. In patients with PJK, lumbar apex and thoracolumbar inflexion point shifted cranially and were too high according to the Roussouly type.
Hybrid and screw instrumentation led to similar global AIS correction, but the use of cantilever reduction in the SG allowed setting the thoracolumbar inflexion point and the lumbar apex lower than in the HG. Cranial migration of these points was identified as PJK risk factor.
Level III.
这是一项回顾性观察研究。
本研究旨在评估后凸和前凸分布、转折点，以及比较混合器械（原位塑形、去旋转）与螺钉器械（胸椎悬臂复位、腰椎原位塑形和去旋转）与近端交界性后凸（PJK）的关系。
复位技术的组合旨在根据鲁索利排列类型恢复腰椎顶点和胸腰段转折点的水平。这种方法可以将青少年特发性脊柱侧凸（AIS）手术后的PJK风险降至最低。
该研究评估了86例骨骼成熟的青少年和年轻成年人在AIS矫正2.2年后的冠状面曲线矫正、胸腰段和脊柱骨盆矢状面参数，将混合组（HG，n = 34）与螺钉组（SG，n = 52）进行比较。使用KEOPS软件对节段性后凸和前凸分布、曲线中包含的椎体数量、胸椎和腰椎顶点、胸腰段转折点和鲁索利类型进行建模。
两组的整体冠状面和矢状面矫正相似。在SG组中，腰椎前凸（LL）从61.1度降至53.9度（P < 0.0001），并与骨盆倾斜度匹配（r = 0.69），而HG组的LL没有变化。术后，胸腰段转折点向头侧迁移，导致两组的LL更长。与HG组相比，SG组术后胸腰段转折点（P < 0.0001）和腰椎顶点（P = 0.0274）更靠尾侧。HG组的PJK发生率为14.7%，SG组为7.7%。在患有PJK的患者中，腰椎顶点和胸腰段转折点向头侧移位，根据鲁索利类型过高。
混合器械和螺钉器械导致相似的整体AIS矫正，但SG组中使用悬臂复位可使胸腰段转折点和腰椎顶点低于HG组。这些点的头侧迁移被确定为PJK的危险因素。
三级。
