Oggiano Leonardo, De Salvatore Sergio, Palombi Davide, Brigato Paolo, Longo Umile Giuseppe, Costici Pier Francesco
Department of Orthopaedic, Bambino Gesù Children's Hospital, Palidoro, Rome, Italy.
Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
Eur J Orthop Surg Traumatol. 2025 Feb 6;35(1):62. doi: 10.1007/s00590-025-04185-9.
Adolescent idiopathic scoliosis (AIS) surgery aims to achieve optimal deformity correction while minimizing complications. The standard open posterior approach (OS) is effective but associated with significant soft tissue disruption and prolonged recovery. The modified mini-open surgery (MS) technique offers a less invasive alternative, potentially reducing surgical morbidity while maintaining comparable correction.
In this prospective comparative study, 60 Lenke type 1 AIS patients with single thoracic curves were randomized to MS (n = 30) or OS (n = 30) groups. The MS technique utilized three midline incisions, a muscle-splitting approach, and selective arthrodesis at instrumented levels. Outcomes included deformity correction, intraoperative blood loss, hospital stay, postoperative pain (VAS), scar satisfaction, fusion rates, and complications at 2 years.
Both groups achieved comparable correction with no loss at 2 years (MS: 79.7% ± 8.0%; OS: 85.0% ± 7.4%; p > 0.05). The MS group had reduced intraoperative blood loss (383.3 ± 82.9 mL vs. 720.2 ± 74.3 mL; p = 0.019), shorter hospital stays (6.2 ± 0.3 vs. 7.4 ± 1.2 days; p = 0.044), and lower VAS scores at discharge (2.9 ± 1.8 vs. 3.9 ± 1.4; p = 0.02) and 2 years (1.5 ± 0.5 vs. 2.0 ± 0.7; p = 0.03). Scar satisfaction was higher in the MS group (4.5 ± 0.3 vs. 2.8 ± 0.6; p = 0.02). No pseudoarthrosis or complications occurred in either group.
The MS approach offers comparable correction to OS with reduced morbidity and superior cosmesis.
青少年特发性脊柱侧凸（AIS）手术旨在实现最佳畸形矫正，同时将并发症降至最低。标准的开放后路手术（OS）有效，但会导致显著的软组织破坏和恢复时间延长。改良的微创外科手术（MS）技术提供了一种侵入性较小的替代方案，有可能在保持相当矫正效果的同时降低手术发病率。
在这项前瞻性比较研究中，60例Lenke 1型单胸弯AIS患者被随机分为MS组（n = 30）或OS组（n = 30）。MS技术采用三个中线切口、肌肉劈开入路以及在置入器械节段进行选择性融合。结果包括畸形矫正、术中失血、住院时间、术后疼痛（视觉模拟评分法[VAS]）、瘢痕满意度、融合率以及2年时的并发症。
两组在2年时均获得了相当的矫正效果且无丢失（MS组：79.7%±8.0%；OS组：85.0%±7.4%；p>0.05）。MS组术中失血量减少（383.3±82.9毫升对720.2±74.3毫升；p = 0.019），住院时间缩短（6.2±0.3天对7.4±1.2天；p = 0.044），出院时（2.9±1.8对3.9±1.4；p = 0.02）和2年时（1.5±0.5对2.0±0.7；p = 0.03）的VAS评分更低。MS组的瘢痕满意度更高（4.5±0.3对2.8±0.6；p = 0.02）。两组均未发生假关节或并发症。
MS手术方法与OS相比，矫正效果相当，发病率降低，美容效果更佳。
