Machida Masayoshi, Rocos Brett, Zeller Reinhard, Lebel David E
Department of Orthopaedic Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
J Child Orthop. 2023 Feb 27;17(2):148-155. doi: 10.1177/18632521231156438. eCollection 2023 Apr.
Managing severe scoliosis is challenging and risky with a significant complication rate regardless of treatment strategy. In this retrospective comparative study, we report our results using a three-rod compared to two-rod construct in the surgical treatment of severe spine deformities to investigate which technique is safer, and which provides superior radiological outcomes.
Forty-six consecutive patients undergoing posterior spine fusion for scoliosis between 2006 and 2017 were identified in our institutional records. Inclusion criteria were minimum coronal deformity of 90°, age < 18 years at the time of surgery and a minimum 2 years of follow-up. Radiographic and clinical parameters, as well as post-operative complications were compared between the two groups.
There were 21 patients in the three-rod group and 25 in the two-rod group. The mean preoperative major coronal deformity was 100°± 9 and 102°± 10 in the three-rod and two-rod, respectively ( = 0.6). The average major curve correction was 51% and 59% in three-rod and two-rod groups, respectively ( = 0.03). The post-operative thoracic kyphosis was 30°± 11 and 21°± 12 in the three-rod and the two-rod groups, respectively ( = 0.01). The surgical time was 476 ± 52 and 387 ± 84 min in three-rod and two-rod, respectively ( < 0.01). One patient in the two-rod cohort showed permanent post-operative sensory deficit. There were three unplanned returns to operating theater in the two-rod group.
Coronal correction was better with two-rod, whereas sagittal balance was superior with three-rod. Both techniques achieved balanced spine treating severe scoliosis. The two-rod technique was associated with a higher likelihood of requiring revision surgery.
level 3.
无论采用何种治疗策略，严重脊柱侧弯的治疗都具有挑战性且风险较大，并发症发生率较高。在这项回顾性比较研究中，我们报告了在严重脊柱畸形手术治疗中使用三棒与两棒结构的结果，以研究哪种技术更安全，哪种技术能提供更好的放射学结果。
在我们机构的记录中确定了2006年至2017年间连续接受后路脊柱融合治疗脊柱侧弯的46例患者。纳入标准为冠状面最小畸形90°、手术时年龄<18岁且至少随访2年。比较两组的影像学和临床参数以及术后并发症。
三棒组有21例患者，两棒组有25例患者。三棒组和两棒组术前平均主要冠状面畸形分别为100°±9和102°±10（P = 0.6）。三棒组和两棒组的平均主要曲线矫正分别为51%和59%（P = 0.03）。三棒组和两棒组术后胸椎后凸分别为30°±11和21°±12（P = 0.01）。三棒组和两棒组的手术时间分别为476±52分钟和387±84分钟（P<0.01）。两棒组中有1例患者术后出现永久性感觉障碍。两棒组有3例计划外返回手术室的情况。
两棒结构在冠状面矫正方面更好，而三棒结构在矢状面平衡方面更优。两种技术在治疗严重脊柱侧弯时均能实现脊柱平衡。两棒技术需要翻修手术的可能性更高。
3级。
