Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD.
J Pediatr Orthop. 2022 Aug 1;42(7):e709-e712. doi: 10.1097/BPO.0000000000002187. Epub 2022 May 17.
Sacral-alar-iliac (SAI) screws are utilized to achieve pelvic fixation in spine deformity patients. The primary purpose of this study is to investigate the long-term outcomes of pediatric patients with scoliosis treated with posterior spinal fusion and SAI fixation at 10-year clinical and radiographic follow-up.
We reviewed the clinical and radiographic records of patients aged 18 years or below treated for scoliosis with posterior spinal fusion using SAI fixation. Pelvic obliquity and the major coronal curve were determined at the preoperative visit and 6-week, 1-year, 5-year, and 10-year postoperative visits. SAI screw-specific data collected included screw dimensions, rate of screw revision, pain at the SAI screw sites, presence of lucency >2 mm around the screw, screw loosening or breaking, and deep surgical site infections.
Ninety-seven of 151 patients (75%) were included. The average age at index surgery was 13.5±3.1 years, and the most common diagnosis was cerebral palsy (67%). The mean duration of follow-up was 11±3 years. The mean pelvic obliquity measured 20±8.0 degrees preoperatively, and 8.7±4.0 degrees at the 10-year follow-up. There were no significant difference in pelvic obliquity when comparing the 10-year follow-up visit with the 6-week postoperative follow-up. Average screw dimensions were 8.4×68.8 mm. By the 10-year follow-up, 4 patients (4%) had at least 1 SAI screw-related complication. Of these patients, 2 (2%) had pain at 1 SAI screw, 4 (4%) had lucency around the screw, and 3 (3%) had broken or loose screws. Two (2%) required SAI screw revision because of late deep wound infection, and underwent exchange with a longer screw. There were no intrapelvic protrusions, vascular, or neurological complications.
SAI screws are a safe and effective method for pelvic fixation in children with spinal deformity. The outcomes at ≥10 years are satisfactory, with low rates of long-term complications and excellent postoperative correction and subsequent maintenance of coronal curvature and pelvic obliquity over time.
Level IV.
骶髂-髂骨（SAI）螺钉用于实现脊柱畸形患者的骨盆固定。本研究的主要目的是在 10 年临床和影像学随访中，调查后路脊柱融合和 SAI 固定治疗的儿童脊柱侧凸患者的长期结果。
我们回顾了 18 岁以下接受后路脊柱融合和 SAI 固定治疗脊柱侧凸患者的临床和影像学记录。在术前、术后 6 周、1 年、5 年和 10 年随访时确定骨盆倾斜度和主要冠状曲线。收集的 SAI 螺钉特定数据包括螺钉尺寸、螺钉修正率、SAI 螺钉部位疼痛、螺钉周围>2mm 的透亮区、螺钉松动或断裂以及深部手术部位感染。
97 例患者（75%）符合纳入标准。索引手术时的平均年龄为 13.5±3.1 岁，最常见的诊断是脑瘫（67%）。平均随访时间为 11±3 年。术前骨盆倾斜度平均为 20±8.0 度，10 年随访时为 8.7±4.0 度。10 年随访与术后 6 周随访时，骨盆倾斜度无显著差异。平均螺钉尺寸为 8.4×68.8mm。在 10 年随访时，有 4 例（4%）患者至少出现 1 例与 SAI 螺钉相关的并发症。这些患者中，2 例（2%）有 1 个 SAI 螺钉处疼痛，4 例（4%）有螺钉周围透亮区，3 例（3%）有螺钉断裂或松动。2 例（2%）因迟发性深部伤口感染而需要 SAI 螺钉修正，并改用更长的螺钉。无盆腔内突出、血管或神经并发症。
SAI 螺钉是治疗儿童脊柱畸形的一种安全有效的骨盆固定方法。≥10 年的结果令人满意，长期并发症发生率低，术后矫正效果好，冠状曲率和骨盆倾斜度随时间推移保持良好。
IV 级。
