Tetreault Tyler A, Myers Annika Y, Valenzuela-Moss Jaqueline, Wren Tishya A L, Heffernan Michael J, Andras Lindsay M
Jackie and Gene Autry Children's Orthopedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS69, Los Angeles, CA, 90027, USA.
Spine Deform. 2025 May;13(3):861-867. doi: 10.1007/s43390-025-01044-9. Epub 2025 Jan 30.
Determine if Sacral Alar-Iliac (SAI) screw diameter is associated with pelvic fixation failure in pediatric patients with neuromuscular scoliosis (NMS) treated with posterior spinal fusion (PSF).
NMS patients from a single institution who underwent PSF with bilateral SAI screw fixation from 2010 to 2021 were retrospectively reviewed. Clinical parameters, SAI screw sizes, and radiographic outcomes were analyzed. Patients with greater or less than two SAI screws, > 21 years old, or with < 2 years of radiographic follow-up were excluded.
142 patients had 284 SAI screws placed. Mean(± SD) age was 13.6 ± 2.7 years. Preoperative curve magnitude averaged 84.3 ± 29.1°. Mean patient weight was 36.4 ± 14.1kg and BMI was 18 ± 5.1. Radiographic follow-up averaged 4.6 ± 2.0 years. Most screws (234/284,82.4%) were < 8.5 mm and 7.5 mm screws were most frequently used (158/248,55.6%). Mean screw diameter was 7.4 ± 0.7 mm. Patients with greater age, weight, and BMI trended towards larger screws. Three patients had five screw complications (1 screw fracture and 4 set screw dislodgments). One screw fracture (1/284,0.4%;7.5 mm diameter) and contralateral set screw dislodgement occurred in a patient at 14 months but was not revised. One patient who had bilateral set screws dislodge 3 months after PSF underwent revision. The remaining patient was asymptomatic and was observed. Screw diameter was not associated with risk of postoperative complications (p = 0.245).
SAI screw fracture is rare after PSF in pediatric patients with NMS. Contrary to pelvic fixation in adults, smaller diameter SAI screws, which may be optimal in patients with smaller anatomy, were not associated with increased risk of screw failure.
III.
确定在接受后路脊柱融合术（PSF）治疗的神经肌肉型脊柱侧凸（NMS）患儿中，骶骨翼-髂骨（SAI）螺钉直径是否与骨盆固定失败相关。
对2010年至2021年在单一机构接受双侧SAI螺钉固定的PSF手术的NMS患者进行回顾性研究。分析临床参数、SAI螺钉尺寸和影像学结果。排除SAI螺钉数量大于或小于2枚、年龄大于21岁或影像学随访时间小于2年的患者。
142例患者共置入284枚SAI螺钉。平均（±标准差）年龄为13.6±2.7岁。术前侧弯度数平均为84.3±29.1°。患者平均体重为36.4±14.1kg，体重指数（BMI）为18±5.1。影像学随访平均为4.6±2.0年。大多数螺钉（234/284，82.4%）直径小于8.5mm，最常用的是7.5mm螺钉（158/248，55.6%）。平均螺钉直径为7.4±0.7mm。年龄、体重和BMI较大的患者倾向于使用较大直径的螺钉。3例患者出现5例螺钉相关并发症（1例螺钉断裂和4例固定螺钉移位）。1例患者在14个月时出现1例螺钉断裂（1/284，0.4%；直径7.5mm）和对侧固定螺钉移位，但未进行翻修。1例患者在PSF术后3个月出现双侧固定螺钉移位，接受了翻修手术。其余患者无症状，予以观察。螺钉直径与术后并发症风险无关（p=0.245）。
在接受PSF治疗的NMS患儿中，SAI螺钉断裂很少见。与成人骨盆固定情况相反，较小直径的SAI螺钉在解剖结构较小的患者中可能是最佳选择，且与螺钉失败风险增加无关。
III级。
