全椎弓根螺钉与钉钩混合系统治疗青少年特发性脊柱侧凸的疗效分析

Pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scolio. sis： results and analysis

目的 通过临床病例回顾，对后路全椎弓根螺钉系统和钉钩混合系统治疗青少年特发性脊柱侧凸的疗效进行对比分析研究。方法 从2000年至2004年进行手术治疗的青少年特发性脊柱侧凸患者中选取60例配对分为两组（A、B两组，各30例），A组采用后路钉钩混合系统固定，B组采用后路全椎弓根螺钉系统固定，配对患者年龄相似、融合节段相仿、Lenke分型相近。通过比较手术前后影像学改变、手术时间、术中出血等，对两种手术方法的疗效进行对比分析研究。结果 A组患者术前冠状面主弯Cobb角平均为61°，术后为25°，平均矫正率为59％；B组患者术前冠状面主弯Cobb角平均为60°，术后为18°，平均矫正率为70％。两组患者主弯矫正率差异有统计学意义（P=0．002），随访2年两组间主弯矫正率差异仍有统计学意义（A、B两组分别为49％、67％，P〈0．001）。矢状面上，与术前相比，术后2年A组的胸椎后凸角平均减少了1°，而B组则减少了6°，差异有统计学意义（P=0．026）。随访结果提示，两组在下端椎远端融合椎体数、平均失血量方面差异均无统计学意义。两组患者术后均未出现神经系统并发症。结论 全椎弓根螺钉系统较钉钩混合系统能提供更好的主弯矫正率，而在最下端固定椎体的选择、术中失血量方面，两种内固定系统未见明显差异。

Objective To comprehensively compare the results of pediele screws versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic seoliosis （AIS）. Methods From 2002 to 2004, a total of 60 AIS patients that underwent posterior fusion with hybrid instrumentation （Group A, 30 patients, 7 males and 23 females, with the mean age of 14.3 years） or pediele screw （Group B, 30 patients, 6 males and 24 females, with the mean age of 13.4 years） instrumentation were sorted and matched according to three criteria： similar patient age, fusion levels and identical Lenke curve type. Patients were compared according to radiographic changes, operative time and intraoperative blood loss. Results The average major Cobb angle was 61° preoperatively in Group A and decreased to 25° postoperatively, and the average major curve correction was 59%; while in Group B, the Cobb angle decrease from 60° preoperatively to 18° postoperatively, the average major curve correction was 70%. At 2-year follow-up, major curve correction was 49% in group A and 67% in group B, respectively （P〈 0.001）. At 2-year follow-up, thoracic sagittal Cobb angle changes between T5 and T12 were 1° decrease in Group A and 6° decrease in Group B compared with preoperative （P=0.026）. Two years following surgery, there were no differences in the lowest instrumented vertebra below the lower end vertebra and average estimated blood loss. There were no neurologic complications related to hybrid or pedicle screw instrumentation. Conclusion Pedicle screw instrumentation offers a significantly better major curve correction without neurologic problems compared with hybrid constructs. Both instrumentation methods offer similar junctional change, lowest instrumented vertebra and blood loss in the operative treatment of AIS.