椎弓根螺钉和椎板钩选择性融合治疗胸椎青少年特发性脊柱侧弯的差异

Selective posterior thoracic fusions for adolescent idiopathic scoliosis:Hooks versus pedicle screws

背景:既往的文献多报道用椎板钩或联合椎弓根螺钉治疗特发性脊柱侧弯或讨论融合节段的选择。目的:比较椎弓根螺钉和椎板钩治疗青少年特发性脊柱侧弯临床疗效的差异,并行影像学评价。方法:选择66例连续观察的青少年特发性脊柱侧弯(胸段主弯、腰段代偿弯)患者,均行后路内固定融合,末端融合到T12或L1椎体。其中32例行椎板钩内固定,34例行椎弓根螺钉内固定,内固定后最少随访2年。结果与结论:椎弓根螺钉组患者内固定后胸段Cobb角矫正程度及腰段Cobb角自发矫正程度明显大于椎板钩组(P<0.001)。椎板钩组内固定后13例患者冠状面朝左侧失代偿大于20mm(参照C7铅垂线),而椎弓根内固定组仅4例,差异有显著性意义(P<0.005)。两组患者均无并发症发生。提示后路选择性融合治疗特发性脊柱侧弯(胸段主弯、腰段代偿弯),与椎板钩相比,椎弓根螺钉有更好的矫正效果且内固定后冠状面失代偿发生率低。

BACKGROUND：Previous reports have documented to use hooks or pedicle screws with hooks in treating adolescent idiopathic scoliosis（AIS）,or to discuss selective spinal segment for fusion.OBJECTIVE：To compare the clinical and radiographic results of selective posterior thoracic fusion using hooks versus pedicle screws in AIS patients.METHODS：Sixty-six consecutive patients with major thoracic-compensatory lumbar C modifier AIS curves underwent selective posterior thoracic fusion to T12 or L1 at a single institution.Hooks were used for instrumentation in 32 patients and pedicle screws were used in 34 patients.Patients were evaluated at a minimal 2-year follow-up.RESULTS AND CONCLUSION：There was no statistical difference between the preoperative thoracic and lumbar Cobb values for the hook group versus the pedicle screw group.The amount of correction obtained surgically of the thoracic Cobb and the amount of spontaneous lumbar Cobb correction were significantly greater in the pedicle screw group（P 0.001）.The incidence of postoperative coronal decompensation,with a greater than 20 mm shift to the left of the C7 plumb line,was higher in the hook group（13 patients） as compared with the pedicle screw group（4 patients）（P 0.005）.There were no complications or reoperations in either group.Selective thoracic fusion of main thoracic-compensatory lumbar C modifier AIS curves with pedicle screws allowed better thoracic correction and less postoperative coronal decompensation than that with hooks.