Kim Hak Sun, Kwon Ji Won, Park Kun-Bo
Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Neurospine. 2022 Mar;19(1):177-187. doi: 10.14245/ns.2143246.623. Epub 2022 Jan 29.
Surgical treatment for neuromuscular scoliosis has evolved with pedicle screw instrumentation and the improvement of perioperative management. We aimed to review recent papers related to posterior surgical correction with a pedicle screw system for neuromuscular scoliosis, particularly cerebral palsy and muscular dystrophy, in terms of indication, correction method, and outcomes. The most remarkable change was the posterior-only operation with all-pedicle screw fixations. With this change, operation time, blood loss, and postoperative complications decreased. Furthermore, spinal osteotomy could be performed with the pedicle screw system for severe scoliosis. S2-alar-iliac screws demonstrated favorable outcomes in terms of stability and complication, but a question remains about saving the mobile segment for sitting balance, interaction between the hip and spine, effect to the sagittal balance, and proximal junctional problem. The quality of life improvement was more definite in patients with cerebral palsy. The improvement of respiratory function in Duchenne muscular dystrophy was not certain, although an increase of spinal height, thoracic cavity size, and absolute forced vital capacity have been reported. Further prospective studies or randomized clinical trials are needed to evaluate the long-term outcomes of lumbosacral fixation, preservation of the lumbosacral joint, or functional improvement considering the different etiology.
随着椎弓根螺钉内固定技术的发展以及围手术期管理的改善，神经肌肉型脊柱侧凸的外科治疗也在不断演进。我们旨在回顾近期有关使用椎弓根螺钉系统对神经肌肉型脊柱侧凸，特别是脑瘫和肌营养不良进行后路手术矫正的相关论文，内容涉及手术指征、矫正方法及手术效果。最显著的变化是采用全椎弓根螺钉固定的单纯后路手术。随着这一变化，手术时间、失血量及术后并发症均有所减少。此外，对于严重脊柱侧凸，可使用椎弓根螺钉系统进行脊柱截骨术。S2-翼-髂骨螺钉在稳定性和并发症方面显示出良好效果，但对于保留活动节段以维持坐姿平衡、髋部与脊柱之间的相互作用、对矢状面平衡的影响以及近端交界区问题仍存在疑问。脑瘫患者的生活质量改善更为明确。尽管有报道称杜氏肌营养不良患者的脊柱高度、胸腔大小及绝对用力肺活量有所增加，但其呼吸功能的改善并不确定。需要进一步的前瞻性研究或随机临床试验来评估腰骶部固定、腰骶关节保留或考虑不同病因的功能改善的长期效果。
