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神经肌肉型脊柱侧弯中基于弯曲凸侧的畸形矫正。

Deformity correction from the convexity of the curve in neuromuscular scoliosis.

作者信息

Hernández Mateo José María, Flores Gallardo Jaime, Riquelme García Oscar, García Martín Azucena, Igualada Blázquez Cristina, Solans López María Coro, Muñoz Núñez Laura, Esparragoza Cabrera Luis Alejandro

机构信息

Department of Traumatology and Orthopaedic Surgery, General University Hospital Gregorio Marañón, Madrid, Spain.

Department of Spine Surgery, General University Hospital Gregorio Marañón, Madrid, Spain.

出版信息

J Spine Surg. 2024 Jun 21;10(2):224-231. doi: 10.21037/jss-23-128. Epub 2024 May 9.


DOI:10.21037/jss-23-128
PMID:38974489
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11224787/
Abstract

BACKGROUND: "Convex Pedicle Screw Technique" reduces the theoretical risk of neurovascular injury. Our aim is to evaluate the efficacy of this technique in patients with neuromuscular scoliosis (NMS). METHODS: Retrospective study of 12 patients who underwent a Convex Pedicle Screw Technique and were diagnosed with NMS. Patients who had undergone previous spinal surgery were excluded. The minimum follow-up required was 24 months. Demographic data, intraoperative data, neurovascular complications and neurophysiological events requiring implant repositioning, as well as pre- and postoperative radiological variables were collected. RESULTS: Twelve patients diagnosed with NMS underwent surgery. The median operative time was 217 minutes. Mean blood loss was 3.8±1.1 g/dL hemoglobin (Hb). The median postoperative stay was 8.8±4 days. A reduction of the Cobb angle in primary curve of 49.1% (from 52.8°±18° to 26.5°±12.6°; P<0.001) and in secondary curve of 25.2% (from 27.8°±18.9° to 18.3°±13.3°; P=0.10) was achieved. Coronal balance improved by 69.4% (7.5±46.2 2.3±20.9 mm; P=0.72) and sagittal balance by 75% (from -14.1±71.8 -3.5±48.6 mm; P=0.50). There were no neurovascular complications. There were no intraoperative neurophysiological events requiring implant repositioning, nor during reduction maneuvers. No infections were reported. CONCLUSIONS: The correction of the deformity from convexity in NMS achieves similar results to other techniques, and a very low complication rate.

摘要

背景:“凸侧椎弓根螺钉技术”降低了神经血管损伤的理论风险。我们的目的是评估该技术在神经肌肉型脊柱侧凸(NMS)患者中的疗效。 方法:对12例行凸侧椎弓根螺钉技术且诊断为NMS的患者进行回顾性研究。排除既往接受过脊柱手术的患者。所需的最短随访时间为24个月。收集人口统计学数据、术中数据、神经血管并发症以及需要重新调整植入物位置的神经生理事件,以及术前和术后的放射学变量。 结果:12例诊断为NMS的患者接受了手术。中位手术时间为217分钟。平均失血量为血红蛋白(Hb)3.8±1.1 g/dL。术后中位住院时间为8.8±4天。主弯的Cobb角减小了49.1%(从52.8°±18°降至26.5°±12.6°;P<0.001),次弯减小了25.2%(从27.8°±18.9°降至18.3°±13.3°;P=0.10)。冠状面平衡改善了69.4%(从7.5±46.2变为2.3±20.9 mm;P=0.72),矢状面平衡改善了75%(从-14.1±71.8变为-3.5±48.6 mm;P=0.50)。没有神经血管并发症。术中及复位操作过程中均未发生需要重新调整植入物位置的神经生理事件。未报告感染情况。 结论:NMS凸侧畸形的矫正与其他技术取得的结果相似,且并发症发生率极低。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5c78/11224787/730835e8a47e/jss-10-02-224-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5c78/11224787/5f7b10eb98eb/jss-10-02-224-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5c78/11224787/730835e8a47e/jss-10-02-224-f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5c78/11224787/5f7b10eb98eb/jss-10-02-224-f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5c78/11224787/730835e8a47e/jss-10-02-224-f2.jpg

相似文献

[1]
Deformity correction from the convexity of the curve in neuromuscular scoliosis.

J Spine Surg. 2024-6-21

[2]
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[3]
Comparative analysis of hook, hybrid, and pedicle screw instrumentation in the posterior treatment of adolescent idiopathic scoliosis.

J Pediatr Orthop. 2012

[4]
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[5]
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[6]
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[7]
Is There Asymmetry Between the Concave and Convex Pedicles in Adolescent Idiopathic Scoliosis? A CT Investigation.

Clin Orthop Relat Res. 2017-3

[8]
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[9]
Pedicle screw instrumentation with or without pelvic fixation in neuromuscular scoliosis: Outcome and complications in a series of 37 patients with a minimum 2-year follow-up.

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[10]
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本文引用的文献

[1]
Pedicle morphometry analysis of main thoracic apex adolescent idiopathic scoliosis.

BMC Surg. 2023-2-9

[2]
Incidence and causes of instrument-related complications after primary definitive fusion for pediatric spine deformity.

J Neurosurg Spine. 2022-9-30

[3]
Freehand power-assisted pedicle screw placement in scoliotic patients: results on 5522 consecutive pedicle screws.

Musculoskelet Surg. 2024-3

[4]
Comparison of four correction techniques for posterior spinal fusion in adolescent idiopathic scoliosis.

Eur Spine J. 2022-4

[5]
Clinical Issues in Indication, Correction, and Outcomes of the Surgery for Neuromuscular Scoliosis: Narrative Review in Pedicle Screw Era.

Neurospine. 2022-3

[6]
Initial intraoperative experience with robotic-assisted pedicle screw placement with stealth navigation in pediatric spine deformity: an evaluation of the first 40 cases.

J Robot Surg. 2021-10

[7]
A novel MRI-based classification of spinal cord shape and CSF presence at the curve apex to assess risk of intraoperative neuromonitoring data loss with thoracic spinal deformity correction.

Spine Deform. 2020-8

[8]
Pedicle screw instrumentation with or without pelvic fixation in neuromuscular scoliosis: Outcome and complications in a series of 37 patients with a minimum 2-year follow-up.

Surgeon. 2020-10

[9]
Correction of Adolescent Idiopathic Scoliosis Using a Convex Pedicle Screw Technique: A Novel Technique for Deformity Correction.

JBJS Essent Surg Tech. 2019-3-13

[10]
Pedicle screw accuracy in clinical utilization of minimally invasive navigated robot-assisted spine surgery.

J Robot Surg. 2020-6

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