Department of Orthopaedics and Traumatology, Antalya Training And Research Hospital, Ankara, Turkey.
Department of Orthopaedics and Traumatology, Ankara Keçiören Training and Research Hospital, Ankara, Turkey.
World Neurosurg. 2021 Jul;151:e672-e681. doi: 10.1016/j.wneu.2021.04.097. Epub 2021 May 1.
The choice of implants in neuromuscular scoliosis (NMS) surgery remains controversial. Sublaminar polyester bands (SPBs) seem to be a promising alternative implant. The purpose of current study was to compare clinical and radiologic results of posterior instrumentation and fusion using hybrid constructs versus only pedicle screws for NMS treatment.
In 24 patients, pedicle screws were used in all segments, and 18 patients underwent hybrid fixation. Cobb angle, thoracic kyphosis, lumbar lordosis angles, and pelvic obliquity were compared before and immediately after surgery, at the last follow-up radiographs. Demographic, clinical information, duration of surgery, estimated blood loss (EBL), blood transfusion, and complications were compared between groups. Additionally, patients were assessed for pain with visual analog scale (VAS) and quality of life with Short Form 36 (SF-36) and the Oswestry scale.
Baseline characteristics of patients were similar except for EBL (P = 0.002) and follow-up duration (P = 0.004). The mean curve correction was 58.1% in the hybrid group, and 67.6% in the screw group (P = 0.07), and loss of correction was significantly lower in hybrid group (2.72° ± 1.48° vs. 3.66° ± 1.52°, P = 0.049). Functional scores at final follow-up were equal in both groups (VAS P = 0.865, Oswestry P = 0.097, SF-36 Physical P = 0.358, SF-36 Mental P = 0.145).
SPBs might be a better fixation alternative at the apex of rigid spinal deformity in NMS. The deformity can be corrected with less blood loss and at a similar rate of correction, with similar rate complications compared with pedicle screws.
在神经肌肉型脊柱侧凸（NMS）手术中，植入物的选择仍存在争议。 皮下聚酯带（SPB）似乎是一种很有前途的替代植入物。本研究的目的是比较使用混合结构与仅使用椎弓根螺钉治疗 NMS 时，后路器械固定融合的临床和影像学结果。
在 24 例患者中，所有节段均使用椎弓根螺钉，18 例患者行混合固定。比较两组患者术前、术后即刻、末次随访时的 Cobb 角、胸椎后凸角、腰椎前凸角和骨盆倾斜角。比较两组患者的一般资料、临床资料、手术时间、估计失血量（EBL）、输血、并发症。此外，采用视觉模拟评分（VAS）评估患者疼痛程度，采用 36 项简明健康状况量表（SF-36）和 Oswestry 功能障碍指数评估患者生活质量。
两组患者的基线特征除 EBL（P=0.002）和随访时间（P=0.004）外，其余均相似。混合组的平均矫正率为 58.1%，螺钉组为 67.6%（P=0.07），混合组的矫正丢失明显更低（2.72°±1.48°比 3.66°±1.52°，P=0.049）。两组患者的最终随访时的功能评分均相同（VAS P=0.865，Oswestry P=0.097，SF-36 躯体评分 P=0.358，SF-36 心理评分 P=0.145）。
在 NMS 中，SPB 可能是刚性脊柱畸形顶点的更好固定选择。与椎弓根螺钉相比，该方法可以减少出血量，以相似的矫正率矫正畸形，且并发症发生率相似。
