Division of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China.
BMC Musculoskelet Disord. 2022 Mar 25;23(1):285. doi: 10.1186/s12891-022-05248-2.
Rib head dislocation (RHD) in dystrophic scoliosis of type 1 neurofibromatosis (DS-NF1) is a unique disorder caused by skeletal dystrophy and scoliotic instability. No particular surgical manipulation is mentioned in the literature to instruct the spine surgeons to effectively obtain more migration of the dislocated rib head without resection. The present study aimed to investigate the effectiveness of screw/hook insertion at vertebrae with RHDs on the retraction of penetrated rib head from spinal canal.
37 neurologically intact patients with DS-NF1 and concomitant 53 RHDs undergoing scoliosis surgery without rib head excision were retrospectively reviewed. We used pre and postoperative whole-spine radiographs to determine the Cobb angle and the vertebral translation (VT), and the CT scans to evaluate the intraspinal rib length (IRL) and rib-vertebral angle (RVA). The dislocated ribs were assigned into two groups according to the presence of screw/hook insertion at vertebrae with RHD: screw/hook group and non-screw/hook group.
37 dislocated ribs with screws/hooks insertion at corresponding vertebrae were assigned into the screw/hook group and the remaining 16 dislocated ribs consisted of the non-screw/hook group. In the screw/hook group, the correction rates of Cobb angle and VT were significantly higher than the non-screw/hook group after surgery (58.7 ± 16.0% vs. 30.9 ± 12.4%, p = 0.003; 61.8 ± 18.8% vs. 35.1 ± 16.6%, p = 0.001; respectively). Similarly, more correction rates of IRL and RVA were found in the screw/hook group than the non-screw/hook group (63.1 ± 31.3% vs. 30.1 ± 20.7%, p = 0.008; 17.6 ± 9.7% vs. 7.2 ± 3.6%, p = 0.006; respectively). Multiple linear regression analysis revealed that the correction rates of Cobb angle, VT and RVA contributed significantly to correction of IRL (β = 0.389, 0.939 and 1.869, respectively; p = 0.019, 0.001 and 0.002, respectively).
Screw/hook insertion at dystrophic vertebrae with RHDs contributed significantly to the degree of retraction of penetrated rib head from spinal canal. This effectiveness is mediated by more corrections of VT and RVA.
1 型神经纤维瘤病（NF1）的营养不良性脊柱侧凸中的肋骨头脱位（RHD）是一种由骨骼营养不良和脊柱侧凸不稳定引起的独特疾病。文献中没有特别提到任何手术操作来指导脊柱外科医生在不切除的情况下有效地获得更多脱位的肋骨头迁移。本研究旨在探讨在 RHD 椎骨中插入螺钉/钩对回缩穿透椎管的肋骨头的效果。
回顾性分析了 37 例 NF1 合并 53 例 RHD 的神经功能完整的患者，这些患者均行脊柱侧凸手术但未切除肋骨头。我们使用术前和术后全脊柱 X 线片确定 Cobb 角和椎体平移（VT），使用 CT 扫描评估椎管内肋长度（IRL）和肋-椎体角（RVA）。根据 RHD 椎骨中是否存在螺钉/钩插入，将脱位肋骨分为两组：螺钉/钩组和非螺钉/钩组。
37 根带有螺钉/钩的脱位肋骨被分配到螺钉/钩组，其余 16 根脱位肋骨构成非螺钉/钩组。在螺钉/钩组中，术后 Cobb 角和 VT 的矫正率明显高于非螺钉/钩组（58.7±16.0%对 30.9±12.4%，p=0.003；61.8±18.8%对 35.1±16.6%，p=0.001；分别）。同样，螺钉/钩组的 IRL 和 RVA 矫正率也高于非螺钉/钩组（63.1±31.3%对 30.1±20.7%，p=0.008；17.6±9.7%对 7.2±3.6%，p=0.006；分别）。多元线性回归分析显示，Cobb 角、VT 和 RVA 的矫正率对 IRL 的矫正有显著贡献（β=0.389、0.939 和 1.869，分别；p=0.019、0.001 和 0.002，分别）。
在 RHD 椎骨中插入螺钉/钩对回缩穿透椎管的肋骨头的程度有显著贡献。这种效果是通过更多的 VT 和 RVA 矫正来介导的。
