Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
Orthop Surg. 2024 Jan;16(1):47-56. doi: 10.1111/os.13943. Epub 2023 Nov 27.
The treatment of scoliosis with a severe rib hump remains a major challenge. Traditional vertebral rotation techniques are not satisfactory, and thoracoplasty has many pulmonary complications that limit its application. A novel surgical device, the multiple screw distraction reducer (MSDR) system, provides longitudinal distraction during the corrective operation while at the same time providing lateral translation and axial derotation, which may facilitate the correction of a rib hump. This study was performed to investigate the effectiveness of the MSDR system for adolescent idiopathic scoliosis (AIS) with a severe rib hump.
This was a case-matched study of patients with retrospectively collected data from our hospital between January 2017 and December 2021. Sixty-eight patients who underwent one-stage posterior pedicle screw-instrumented spinal fusion were matched by the Cobb angle of the main curve and rib hump. All patients underwent a minimum of 2 years of follow-up. The patients were divided into two groups: the MSDR group (using the MSDR system, n = 34) and the DVR group (using direct vertebral derotation, n = 34). The patients were evaluated for the height of the rib hump, deformity correction, complications, and SRS-30 scores. The unpaired Student's t-test and Pearson's χ -test were used to compare the outcome measures between the two groups. Multiple linear regression analysis was used to examine the variables that affected the correction of a rib hump.
The rib hump was 30.21 ± 6.21 mm versus 29.35 ± 6.52 mm (p = 0.583) preoperatively and 9.18 ± 4.06 mm versus 13.82 ± 5.54 mm (p < 0.001) at the last follow-up in the MSDR and DVR groups, respectively. The correction rates were 70.83% and 53.56%, respectively (p < 0.001). Preoperatively, the main thoracic curve was 58.43° ± 7.97° and 57.84° ± 6.32° (p = 0.736) and was corrected to 10.92° ± 5.47° and 19.14° ± 5.32° (p < 0.001) at last follow-up in the MSDR and DVR group, respectively. Thoracic kyphosis was restored from 18.24° ± 5.19° and 17.98° ± 5.28° (p = 0.836) in the MSDR and DVR group to 24.59° ± 4.41° and 19.32° ± 4.96° (p < 0.001), respectively. Correction of apical vertebra rotation and translation in the main thoracic curve were significantly better in the MSDR group than in the DVR group (p < 0.05). There was no significant difference in the Lenke type, implant density, estimated blood loss, or follow-up duration between the two groups, whereas the operation time in the DVR group was significantly less than that in the MSDR group. There were only two minor pulmonary complications in the MSDR group. At the last follow-up, the MSDR group scored higher in terms of appearance and satisfaction (p < 0.05).
The MSDR system, enabling better coronal alignment, thoracic kyphosis, and axial derotation, could be a safe and effective technique for severe rib hump correction in AIS.
严重肋骨隆凸的脊柱侧弯治疗仍然是一个主要挑战。传统的椎体旋转技术并不令人满意，胸廓成形术有许多肺部并发症，限制了其应用。一种新型的手术器械，多螺钉牵张复位器（MSDR）系统，在矫正操作过程中提供纵向牵张，同时提供侧向平移和轴向旋转，这可能有助于矫正肋骨隆凸。本研究旨在探讨 MSDR 系统治疗严重肋骨隆凸的青少年特发性脊柱侧弯（AIS）的疗效。
这是一项回顾性病例匹配研究，对我院 2017 年 1 月至 2021 年 12 月期间收集的数据进行了回顾性分析。通过主弯 Cobb 角和肋骨隆凸角对 68 例接受一期后路椎弓根螺钉内固定脊柱融合术的患者进行了匹配。所有患者均随访至少 2 年。患者分为两组：MSDR 组（使用 MSDR 系统，n=34）和 DVR 组（使用直接椎体旋转，n=34）。评估患者的肋骨隆凸高度、畸形矫正、并发症和 SRS-30 评分。采用配对学生 t 检验和 Pearson χ 2 检验比较两组患者的结局指标。采用多元线性回归分析影响肋骨隆凸矫正的变量。
MSDR 组和 DVR 组患者的肋骨隆凸术前分别为 30.21±6.21mm 和 29.35±6.52mm（p=0.583），末次随访时分别为 9.18±4.06mm 和 13.82±5.54mm（p<0.001）。矫正率分别为 70.83%和 53.56%（p<0.001）。术前主胸弯分别为 58.43°±7.97°和 57.84°±6.32°（p=0.736），末次随访时分别矫正至 10.92°±5.47°和 19.14°±5.32°（p<0.001）。MSDR 组和 DVR 组患者的胸曲由术前的 18.24°±5.19°和 17.98°±5.28°分别矫正至术后的 24.59°±4.41°和 19.32°±4.96°（p<0.001）。主胸弯顶椎旋转和移位的矫正明显优于 DVR 组（p<0.05）。两组患者的 Lenke 类型、植入物密度、估计失血量和随访时间无显著差异，而 DVR 组的手术时间明显少于 MSDR 组。MSDR 组仅发生 2 例轻微肺部并发症。末次随访时，MSDR 组在外观和满意度方面得分更高（p<0.05）。
MSDR 系统能够更好地实现冠状面矫正、胸曲矫正和轴向旋转，可能是治疗 AIS 严重肋骨隆凸的一种安全有效的技术。
