Kaneda K, Shono Y, Satoh S, Abumi K
Department of Orthopaedic Surgery, Hokkaido University School of Medicine, Japan.
Spine (Phila Pa 1976). 1997 Jun 15;22(12):1358-68. doi: 10.1097/00007632-199706150-00015.
Analysis of the clinical results of 20 patients with thoracic scoliosis treated by anterior procedure with Kaneda anterior spinal system.
To evaluate the efficacy of the anterior surgical correction procedure with a new anterior instrumentation in thoracic scoliosis.
Posterior correction and fusion with posterior instrumentation has been a main component of the surgical management of thoracic scoliosis. However, to the best of the authors' knowledge, no clinical results of anterior instrumentation surgery for thoracic scoliosis have been published in the English literature.
Anterior correction and fusion using Kaneda anterior spinal system was performed in 20 patients with thoracic scoliosis (3 patients with King Type II curve, 13 with Type III, and 4 with Type IV). The average follow-up was 3 years, with a range of 2 years, 3 months to 4 years, 1 month. There were 1B patients with idiopathic scoliosis (13 adolescents and 5 adults) and 2 patients with a single thoracic curve caused by other etiologies. All patients had correction of scoliosis by fusion within the major thoracic curve. Radiographic evaluations were performed to analyze frontal, sagittal, and rotational deformities of the spine.
The average correction rate of scoliosis was 71%. Above the instrumented levels, the correction rate was 75%. Preoperative kyphosis of the instrumented levels of 7 degrees was corrected to 14 degrees of kyphosis. The trunk shift was improved from 17 mm before surgery to 9 mm at final follow-up evaluation. The average improvement of the tilt-angle in the lower and vertebra of fusion was 81%, and was 83% in the stable vertebra. Apical vertebral rotation showed correction rate of 15% in patients without performing resection of the rib head joints and rod rotation maneuver (n = 6). However, the correction rate was improved to 58% after introduction of the technique discussed (n = 14). The angle of tangential rib deformity (rib hump) showed a correction rate of 50%. There was 1.2 degrees of frontal plane and 1.0 degree of sagittal plane correction loss within the instrumented area at final follow-up evaluation. At final follow-up, nonunion at the uppermost segment of the fusion range developed in one patient, and decompensation in the lumbar spine was observed in one patient with Type II curve.
Anterior correction with Kaneda anterior spinal system provides excellent correction of the frontal curvature and sagittal alignment by fusing within the range of the major curve, without a significant loss of correction and implant failure. Rigid rotational deformity of the thoracic scoliosis is effectively corrected by resection of the rib head joints and rod rotation maneuver. However, too much correction of the thoracic curve should be avoided, to prevent decompensation of the lumbar curve, especially in Type II curves.
分析20例采用Kaneda前路脊柱系统前路手术治疗的胸椎侧弯患者的临床结果。
评估一种新型前路内固定器械用于胸椎侧弯前路手术矫正的疗效。
后路矫正及后路器械融合术一直是胸椎侧弯手术治疗的主要组成部分。然而，据作者所知，英文文献中尚未发表过胸椎侧弯前路器械手术的临床结果。
对20例胸椎侧弯患者（3例King II型曲线，13例III型，4例IV型）采用Kaneda前路脊柱系统进行前路矫正及融合。平均随访3年，范围为2年3个月至4年1个月。18例为特发性脊柱侧弯患者（13例青少年和5例成人），2例为其他病因导致的单一胸段曲线患者。所有患者均通过融合主要胸段曲线来矫正脊柱侧弯。进行影像学评估以分析脊柱的额状面、矢状面和旋转畸形。
脊柱侧弯平均矫正率为71%。在器械置入节段上方，矫正率为75%。器械置入节段术前7°的后凸畸形矫正至14°的后凸。躯干偏移从术前的17mm改善至末次随访评估时的9mm。融合节段下位椎体和稳定椎体倾斜角的平均改善率分别为81%和83%。在未进行肋骨小头关节切除和棒旋转操作的患者（n = 6）中，顶椎旋转的矫正率为15%。然而，在引入所讨论的技术后（n = 14），矫正率提高到了58%。切线肋骨畸形（肋骨隆突）的矫正率为50%。末次随访评估时，器械置入区域内在额状面有1.2°和矢状面有1.0°的矫正丢失。在末次随访时，1例患者在融合范围的最上段出现不愈合，1例II型曲线患者观察到腰椎失代偿。
采用Kaneda前路脊柱系统进行前路矫正，通过在主要曲线范围内融合，可实现对额状面弯曲和矢状面排列的良好矫正，且矫正丢失和内植物失败不明显。通过切除肋骨小头关节和棒旋转操作可有效矫正胸椎侧弯的僵硬旋转畸形。然而，应避免对胸段曲线过度矫正，以防腰椎曲线失代偿，尤其是在II型曲线患者中。
