青少年特发性胸腰段／腰段侧凸前路与后路矫形效果的比较

Comparison of correction outcomes after anterior or posterior approach with lowest and vertebra instrumentation in adolescent idiopathic thoracolumbar/lumbar scoliosis

目的分析比较不同手术入路（远端融合椎均位于下端椎）对青少年特发性胸腰段／腰段侧凸矫形效果的影响。方法回顾性分析青少年特发性胸腰段／腰段侧凸患者接受前路（单棒矫形固定融合，组A）或后路（全椎弓根螺钉矫形固定融合，组B）矫形固定融合手术术前、术后及随访时的X线片，对侧凸Cobb角、侧凸矫形率、椎间角的变化进行测量和分析。结果组A共18例患者，组B共21例患者。胸腰弯／腰弯冠状面侧凸累及椎体节段数分别为5．0和5．4个（P=0．134），融合椎体数分别为4．7和5．4个（P=0．008）。组A与组B术前、术后胸腰弯／腰弯冠状面Cobb角分别为49．2°和10．3°，43．8°和5．0°，术后较术前均得到明显改善（均P=0．000），矫形率分别为78．5％和87．8％（P=0．020）。随访时冠状面Cobb角分别为21．7°和7．7°，矫形平均丢失8．3°和2．7°（P=0．001）。术前、术后及随访时椎间角组A分别为3．1°、5．6°和7．3°，组B分别为2．3°、4．2°和4．4°，术后椎间角较术前增大，组A差异存在统计学意义（P=0．049），组B差异无统计学意义（P=0．050），组A与组B比较差异无统计学意义（P=0．231）；随访时椎间角较术后增大，与术后相比，二组差异均无统计学意义（P=0．112，P=0．855），但组A较组B椎间角大（P=0．026）。随访时近端交界性后凸的发生组问比较差异无统计学意义（P=0．235）。结论对于青少年特发性胸腰段／腰段侧凸，在远端融合椎止于下端椎时，采用后路全椎弓根螺钉矫形固定融合手术侧凸冠状面矫形率、矫形丢失、椎间角的变化优于前路手术，但融合节段长。

Objective To evaluate the different influences upon the correction outcomes after anterior or posterior correction and fusion with lowest end vertebra instrumentation in adolescent idiopathic thoracolumbar/lumbar scoliosis. Methods By reviewing the medical records and roentgenograms of adolescent idiopathic thoracolumbar/lumbar scoliosis patients undergoing anterior （single rod-Group A） or posterior （all pedicle screws-Group B） correction and instrumentation, the paramaters of Cobb angle of the curve, correction rate and disc angle were measured and analyzed. Results There were 18 patients in Group A and 21 patients in Group B. The curve included 5.0 vertebrae and 5.5 vertebrae （P = 0. 134） respectively, and the fusion levels were 4. 7 vertebrae and 5.4 vertebrae （ P = 0. 008 ） respectively. The mean pre-operative and post-operative coronal Cobb angles of the main curve in Groups A and B were 49.2° and 10. 3°, 42. 2° and 5.0° with an average correction rate of 78.5% and 87.8% respectively. The Cobb angles were all significantly corrected （ all P = 0. 000 ） , and group B had a better correction result （ P = 0. 020）. At final follow-up, the coronal Cobb angles in the two groups were 21.7° and 7. 7° with an average correction loss of 8.3° and 2. 7° （ P = 0. 001 ） respectively. The disc angles at pre-operation, post-operation and inal follow-up were 3.1°, 5.6° and 7.3° in Group A and 2. 3°, 4. 2° and 4.4° in Group B respectively. The disc angle at post-operation was larger than that at pre-operation and the difference was significant in Group A （ P = 0. 049 ） while not in Group B （ P = 0. 050 ）. The difference of post-operative disc angle between two groups was not significant （P = 0. 231 ）. At final follow-up, the disc angle was a little larger than that of post-operation without a significant difference （P = 0. 112, P = 0. 855 ） while Group A had a larger disc angle （ P = 0. 026 ）. At final follow-up, the occurrence of proximal junctional kyphosis between Groups A and B was not significant （P = 0. 235 ） . Conclusion For adolescent idiopathic thoracolumbar/lumbar scoliosis, in comaprison with the anterior approach, the posterior approach using all pedicle screws can achieve a better correction outcome, a less correction loss of coronal Cobb angle and a better disc angle with a longer fusion range.