Wolff Stéphane, Moreau Pierre-Emmanuel, Miladi Lotfi, Riouallon Guillaume
Service de Chirurgie Orthopédique, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades, Paris, France.
Global Spine J. 2024 Sep;14(7):1909-1919. doi: 10.1177/21925682231159347. Epub 2023 Feb 21.
Prospective cohort study.
To report the results for an alternative technique based on minimally invasive fusion-less surgery. This approach is original in that it corrects deformities by proximal and distal fixation, with reliable pelvic fixation through the use of iliosacral screws on osteoporotic bones.
Adult cerebral palsy patients requiring spinal correction surgery were included prospectively between 2015 and 2019. The technique involved the use of a double-rod construct anchored proximally by four clawed hooks and distally by iliosacral screws, in a minimally invasive approach. Cobb angle and pelvic obliquity were measured before and after initial surgery and at final follow-up. Complications and functional results were reviewed. This group (P) was compared with a second group (R) of patients who underwent surgery between 2005 and 2015, for whom data were collected retrospectively.
Thirty-one patients were included in group P, and 15 in group R. The two groups were comparable for demographic data and deformity. At most recent follow-up (3 years for group P [2-6] and 5 years for group R [2-16]), neither correction nor surgical complications differed between the two groups. However, group P had 50% less blood loss and a lower medical complication rate than group R.
Our results confirm the effectiveness of this minimally invasive technique for neuromuscular scoliosis in adults. The results were similar to those obtained with the usual techniques, but with fewer medical complications. Confirmation of these results is now required for a longer follow-up period.
前瞻性队列研究。
报告一种基于微创无融合手术的替代技术的结果。该方法的独特之处在于通过近端和远端固定来矫正畸形，在骨质疏松的骨骼上使用髂骶螺钉实现可靠的骨盆固定。
前瞻性纳入2015年至2019年间需要脊柱矫正手术的成年脑瘫患者。该技术采用微创方法，使用双棒结构，近端由四个爪形钩固定，远端由髂骶螺钉固定。在初次手术前后及最终随访时测量Cobb角和骨盆倾斜度。回顾并发症和功能结果。将该组（P）与2005年至2015年间接受手术的第二组患者（R）进行比较，后者的数据为回顾性收集。
P组纳入31例患者，R组纳入15例患者。两组在人口统计学数据和畸形方面具有可比性。在最近的随访中（P组3年[2 - 6年]，R组5年[2 - 16年]），两组在矫正效果和手术并发症方面均无差异。然而，P组的失血量比R组少50%，医疗并发症发生率也更低。
我们的结果证实了这种微创技术治疗成人神经肌肉性脊柱侧凸的有效性。结果与常规技术相似，但医疗并发症更少。现在需要更长的随访期来证实这些结果。
