用于矫正青少年特发性脊柱侧凸Lenke 5型曲线的选择性直接椎体旋转内固定术
Selective Direct Vertebral Rotation Instrumentation for the Correction of Adolescent Idiopathic Scoliosis Lenke 5 Curve.
作者信息
Alonge Emmanuel, Zhang HongQi, Guo Chaofeng, Yuxiang Wang
机构信息
Department of Spinal Surgery and Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan Province, China.
National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China.
出版信息
Int J Spine Surg. 2025 Mar 6;19(1):96-103. doi: 10.14444/8700.
BACKGROUND
Direct vertebral rotation (DVR) effectiveness in improving scoliosis correction outcomes remains unclear and requires further investigation.
PURPOSE
This study aimed to evaluate the effectiveness of short and extended fusion techniques using en-bloc DVR in correcting adolescent idiopathic scoliosis (AIS) classified as Lenke 5 curve (5C).
MATERIALS AND METHODS
This retrospective study included 90 randomly selected AIS patients with Lenke 5C who underwent posterior spinal instrumentation surgery using en-bloc DVR between 2014 and 2021. Patients were divided into 2 groups: (1) extended fusion, Group A ( = 40): upper instrumented vertebra = upper-end vertebra +1 or +2 or (2) short fusion, Group B ( = 50): upper instrumented vertebra = upper-end vertebra. Radiographic parameters were compared preoperatively and at postoperative follow-ups of 6 months, 3 years, and more.
RESULTS
The mean follow-up duration was 37.5 ± 6 months for Group A and 40.0 ± 8 months for Group B ( = 0.596). The coronal balance correction rate was comparable between the 2 groups, with no significant differences observed at the final follow-up. Significant differences were noted in the fused segment, with Group A having an average fusion rate of 6.8 ± 0 compared with 6.3 ± 0 in Group B ( = 0.001). TK and lumbar lordosis measurements at the final follow-up did not show significant differences between the groups. However, substantial differences were observed in rib hump correction, with Group A demonstrating a better correction rate than Group B at both 6 months and the last follow-up ( = 0.001 for both time points).
CONCLUSION
Selective DVR spinal instrumentation effectively corrects AIS Lenke 5C. However, extended fusion demonstrates more efficient correction and greater improvement in the patient's cosmetic appearance, including better thoracic curve correction, rib hump correction, and shoulder balance, compared with short-level fusion.
背景
直接椎体旋转（DVR）在改善脊柱侧弯矫正效果方面的有效性仍不明确，需要进一步研究。
目的
本研究旨在评估使用整块DVR的短节段和长节段融合技术在矫正Lenke 5型曲线（5C）的青少年特发性脊柱侧弯（AIS）中的有效性。
材料与方法
这项回顾性研究纳入了90例随机选择的Lenke 5C型AIS患者，这些患者在2014年至2021年间接受了使用整块DVR的后路脊柱内固定手术。患者分为两组：（1）长节段融合，A组（n = 40）：上固定椎 = 上端椎 +1或 +2；或（2）短节段融合，B组（n = 50）：上固定椎 = 上端椎。比较术前以及术后6个月、3年及更长时间随访时的影像学参数。
结果
A组的平均随访时间为37.5 ± 6个月，B组为40.0 ± 8个月（P = 0.596）。两组的冠状面平衡矫正率相当，在最终随访时未观察到显著差异。在融合节段存在显著差异，A组的平均融合率为6.8 ± 0，而B组为6.3 ± 0（P = 0.001）。最终随访时胸腰弯（TK）和腰椎前凸测量结果在两组间未显示出显著差异。然而，在肋骨隆凸矫正方面观察到显著差异，A组在6个月和最后随访时的矫正率均优于B组（两个时间点P均 = 0.001）。
结论
选择性DVR脊柱内固定可有效矫正AIS Lenke 5C。然而，与短节段融合相比，长节段融合在矫正方面更有效，并且在改善患者外观方面效果更显著，包括更好地矫正胸弯、肋骨隆凸以及肩部平衡。
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