Gallazzi Enrico, Pallotta Ludovica Maria, La Maida Giovanni Andrea, Luca Andrea, Bassani Tito, Brayda-Bruno Marco
U.O. Ortopedia e Traumatologia per le Patologie della Colonna Vertebrale, ASST Gaetano Pini - CTO, Milan, Italy.
Dipartimento di Scienze Biomediche per la Salute, Università Degli Studi Di Milano, Milan, Italy.
Eur Spine J. 2023 Jan;32(1):202-209. doi: 10.1007/s00586-022-07449-8. Epub 2022 Nov 13.
Hybrid constructs with sublaminar bands have recently regained popularity as an alternative to all-screw construct for correction of adolescent idiopathic scoliosis (AIS). The aim of this study is to evaluate the ability of hybrid constructs with sublaminar bands to achieve a tridimensional correction of the scoliotic deformity. Our hypothesis is that hybrid construct with sublaminar bands are able to achieve a substantial derotation of the apical vertebrae, while preserving the thoracic kyphosis.
A prospective evaluation of 50 consecutive cases (41 F, 9 M, mean age 14.7 ± 2 years) of AIS correction with hybrid construct was performed. In all cases, sublaminar bands were used at the apex of the main curve on concave side. All patients underwent pre and postoperative X-rays with EOS System, with full 3D reconstruction. Spinopelvic parameters and axial rotation of the vertebrae were measured pre and postoperatively.
2.7 ± 0.9 mean sublaminar bands were used per patient. Mean correction of deformity was 50 ± 9.5%. on the coronal plane. The mean axial rotation of the apical vertebra went from 18° ± 11.5° preoperatively to 9.4° ± 7.2° postoperatively (p < 0.001) with a mean derotation of 47.7%. Thoracic kyphosis went from 32.1° ± 18° preoperatively to 37.3° ± 13.1° postoperatively (p < 0.05). No intraoperative complications due to sublaminar bands were recorded.
Hybrid construct with sublaminar band have been showed to be safe and effective in deformity correction and in maintaining or restoring thoracic kyphosis. This study showed that with sublaminar bands applied at the curve apex a substantial derotation of the apical vertebrae can be achieved.
带有椎板下带的混合结构最近重新受到关注，成为青少年特发性脊柱侧凸（AIS）矫正中全螺钉结构的替代方案。本研究的目的是评估带有椎板下带的混合结构实现脊柱侧凸畸形三维矫正的能力。我们的假设是，带有椎板下带的混合结构能够在保留胸椎后凸的同时，使顶椎得到显著的去旋转。
对50例连续使用混合结构矫正AIS的病例（41例女性，9例男性，平均年龄14.7±2岁）进行前瞻性评估。所有病例中，在主弯凹侧顶点使用椎板下带。所有患者术前和术后均使用EOS系统进行X线检查，并进行全三维重建。术前和术后测量脊柱骨盆参数以及椎体的轴向旋转。
每位患者平均使用2.7±0.9条椎板下带。在冠状面上，畸形的平均矫正率为50±9.5%。顶椎的平均轴向旋转术前为18°±11.5°，术后为9.4°±7.2°（p<0.001），平均去旋转率为47.7%。胸椎后凸术前为32.1°±18°，术后为37.3°±13.1°（p<0.05）。未记录到因椎板下带导致的术中并发症。
带有椎板下带的混合结构已被证明在畸形矫正以及维持或恢复胸椎后凸方面是安全有效的。本研究表明，在弯曲顶点应用椎板下带可实现顶椎的显著去旋转。
