连续置钉、间断置钉和关键椎置钉治疗Lenke Ⅰ型青少年特发性脊柱侧凸的疗效对比

Comparisons of consecutive, interval and skipped pedicle screw fixations for Lenke type 1 adolescent idiopathic scoliosis

目的对比连续置钉、间断置钉和关键椎置钉三种手术方式矫正LenkeⅠ型青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）的疗效。方法回顾性分析2009年1月至2014年6月期间，在我院实施后路椎弓根螺钉融合的89例LenkeⅠ型AIS患儿，所有患儿至少1年随访。依据不同的置钉矫形技术分成3组，连续性置钉组（C组）28例，间断置钉组（I组）30例，关键椎置钉组（K组）31例。提取患儿一般资料、围手术期各项指标、生活质量评分，测量术前、术后2周和末次随访的影像学参数。采用单因素方差分析方法（one-way ANOVA）进行3组间相互比较。结果三种置钉技术治疗LenkeⅠ型AIS患儿的末次随访的侧弯矫形率差异无统计学意义。关键椎置钉组相比间断置钉组和连续性置钉组可减少手术时间（283.1 min、301.6 min、359.5 min）、术中出血量（882.4 ml、935.2 ml、1120.0 ml）、植入物费用（9855.1元、12 706.5元、14 907.8元）。三组患儿术前和末次随访的SRS-22评分均无统计学意义（P〉0.05）。结论对于LenkeⅠ型AIS患儿，3种置钉技术获得相当的矫形效果，但关键椎置钉组相比其他两组明显减少患儿的手术时间、术中出血量和植入物花费，因此关键椎置钉技术可作为更加良好的手术选择。

ObjectiveTo compare the perioperative, radiographic and functional outcomes of consecutive, interval and skipped pedicle screw fixations for Lenke type 1 adolescent idiopathic scoliosis （AIS）.MethodsFrom January 2009 to June 2014, retrospective reviews were conducted for 89 consecutive patients with Lenke type 1 AIS undergoing posterior spinal pedicle screw fusion. The follow-up period was at least 1 year.According to different pedicle screw techniques, they were divided into consecutive group （C, n=28）, interval group （I, n=30） and skipped group （S, n=31）. The relevant parameters included patient profile, perioperative indicators, preoperative status, 2 weeks postoperative and the final follow-up.Three groups were compared with one-way ANOVA.ResultsNo statistical differences existed in correction rate at the last follow-up among three pedicle techniques for Lenke type 1 AIS.Decreased surgical duration （283.1, 301.6, 359.5 min）, intraoperative blood loss （882.4, 935.2, 1120.0 ml）and implant cost （￥ 9855.1, ￥12 706.5, ￥14 907.8）were found in I group compared to S and C groups（P〈0.05）. No significant differences existed in SRS-22 outcomes compared with three groups at pre-operation and the final follow-up.ConclusionsConsecutive, interval and skipped pedicle screw techniques all provide satisfactory deformity correction.However, compared with the other two groups, skipped pedicle screw fixation can significantly reduce the surgical duration, intraoperative blood loss and implant cost.Therefore skipped pedicle screw fixation is a better surgical option.