Marsicano J G, Lenke L G, Bridwell K H, Chapman M, Gupta P, Weston J
Washington University School of Medicine, Department of Orthopaedic Surgery, St. Louis, Missouri, USA.
Spine (Phila Pa 1976). 1998 Jun 15;23(12):1341-8. doi: 10.1097/00007632-199806150-00009.
A prospective evaluation of adolescent idiopathic scoliosis patients undergoing operative treatment on the Orthopedic Systems Incorporated (OSI; Jackson) frame.
To investigate prospectively thoracic, thoracolumbar, and lumbar sagittal alignments in patients with adolescent idiopathic scoliosis who undergo an instrumented posterior spinal fusion on the OSI frame.
In several studies, it has been shown that patient positioning on various operative frames is an important component of ultimate lumbar sagittal alignment. However, these studies have all concentrated on the lumbar spine, and no sagittal plane alignment data in adolescent idiopathic scoliosis patients have been reported in the thoracic and thoracolumbar junction as it relates to intraoperative positioning, correction maneuvers and correlative postoperative results.
Thirty-nine patients with operative adolescent idiopathic scoliosis treated with an instrumented posterior spinal fusion on the OSI frame were prospectively evaluated. Standing preoperative, intraoperative, and postoperative long-cassette lateral radiographs were reviewed with regional and segmental Cobb measurements of the thoracic, thoracolumbar junction, and lumbar spine obtained.
Thoracic kyphosis (T1-T12) measured +34 degrees before surgery, +28 degrees during surgery, and +30 degrees after surgery, Thus, a statistically significant decrease was noted in thoracic kyphosis secondary to prone positioning on the OSI frame ( P < 0.05). Thoracolumbar spine measurements from T10 to L2 also showed a lordotic trend from +2 degrees before surgery, to -4 degrees during surgery, to -8 degrees after surgery, which was also statistically significant (P < 0.05). Total lumbar lordosis from T12 to S1 remained relatively unchanged from -60 degrees before surgery, to -59 degrees during surgery, to -60 degrees after surgery. However, segmental lumbar lordosis measured from T12 to the lowest instrumented vertebra showed a statistically significant increase in lordosis from -17 degrees before surgery, to -19 degrees during surgery, to -23 degrees after surgery (P < 0.05). Those patients in whom lumbar pedicle screws were used (vs. hooks alone) had the greatest increase in lumbar instrumented lordosis.
Performing adolescent idiopathic scoliosis correction on the OSI frame tends to decrease thoracic kyphosis, increase thoracolumbar lordosis, and increase segmental instrumented lumbar lordosis, while it maintains total lumbar lordosis.
对在骨科系统公司（OSI；杰克逊）框架上接受手术治疗的青少年特发性脊柱侧凸患者进行前瞻性评估。
前瞻性研究在OSI框架上接受后路器械脊柱融合术的青少年特发性脊柱侧凸患者的胸段、胸腰段和腰段矢状面排列情况。
在多项研究中，已表明患者在各种手术框架上的体位是最终腰椎矢状面排列的重要组成部分。然而，这些研究都集中在腰椎，尚无关于青少年特发性脊柱侧凸患者胸段和胸腰段交界区矢状面排列与术中体位、矫正操作及相关术后结果关系的数据报道。
对39例在OSI框架上接受后路器械脊柱融合术治疗的青少年特发性脊柱侧凸手术患者进行前瞻性评估。回顾术前、术中和术后站立位长片侧位X线片，测量胸段、胸腰段交界区和腰段的区域和节段Cobb角。
术前胸段后凸（T1-T12）为+34°，术中为+28°，术后为+30°。因此，在OSI框架上俯卧位导致胸段后凸有统计学意义的降低（P<0.05）。胸腰段脊柱从T10到L2的测量也显示出从术前的+2°到术中的-4°再到术后的-8°的前凸趋势，这也具有统计学意义（P<0.05）。从T12到S1的总腰椎前凸术前为-60°，术中为-59°，术后为-60°，相对保持不变。然而，从T12到最低固定椎体测量的节段性腰椎前凸显示出从术前的-17°到术中的-19°再到术后的-23°的统计学显著增加（P<0.05）。使用腰椎椎弓根螺钉（与仅使用钩相比）的患者腰椎器械固定前凸增加最大。
在OSI框架上进行青少年特发性脊柱侧凸矫正往往会降低胸段后凸，增加胸腰段前凸和节段性器械固定腰椎前凸，同时保持总腰椎前凸。
