单平面椎弓根螺钉矫正Lenke 5型青少年特发性脊柱侧凸顶椎旋转

Apical vertebral derotation by using uniplanar pedicle screw in Lenke 5 adolescent idiopathic scoliosis

目的对单平面椎弓根螺钉和万向椎弓根螺钉矫正Lenke 5型青少年特发性脊柱侧凸(AIS)顶椎旋转的效果进行对比分析。方法回顾性分析2010年1月—2013年12月收治的72例应用万向/单平面椎弓根螺钉行后路三维矫形植骨融合内固定术的Lenke 5型AIS患者的临床资料,其中使用万向椎弓根螺钉治疗(A组)43例,使用单平面椎弓根螺钉治疗(B组)29例。记录手术前后腰椎侧凸Cobb角和腰椎前凸角,并计算侧凸矫正率。术前使用Nash-Moe法评估顶椎旋转程度,术后根据Upasani等提出的X线椎体旋转分级标准评价顶椎去旋转的效果。结果所有患者均顺利完成手术。2组患者术前侧凸Cobb角及腰椎前凸角差异无统计学意义(P> 0.05);2组术后2周及1年侧凸Cobb角及腰椎前凸角均较术前显著改善,差异有统计学意义(P <0.05);A组术后1年侧凸矫正率为79.2%,B组为81.4%,差异无统计学意义(P> 0.05)。2组患者术前顶椎旋转程度差异无统计学意义(P> 0.05);术后2周及1年顶椎去旋转程度B组优于A组,差异有统计学意义(P <0.05)。结论两种椎弓根螺钉都能很好地矫正Lenke 5型AIS患者冠状面侧凸,单平面椎弓根螺钉在矫正及维持顶椎去旋转效果方面优于万向椎弓根螺钉。

Objective To compare the efficiency between uniplanar pedicle screw and multiaxial pedicle screw in correcting the apical vertebral rotation of Lenke5adolescent idiopathic scoliosis(AIS).Methods From January2010to December2013,the clinical data of72patients with Lenke5AIS treated with posterior three-dimensional orthodontic bone grafting,fusion and internal fixation were analyzed retrospectively,including43cases using multiaxial pedicle screws(group A)and29using uniplanar screws(group B).The pre-and post-operative lumbar scoliosis Cobb’s angles were recorded,and the correction rate of scoliosis was calculated.Nash-Moe method was used to evaluate the extent of apical vertebra rotation at pre-operation,while the derotation effect of the apical vertebra at post-operation was evaluated according to the Upasani’s method.Results All patients completed the operation successfully.There was no significant difference in the lumbar Cobb’s angle and lordosis angle between the2groups at pre-operation(P>0.05);the Cobb’s angle and lordosis angle of the2groups were significantly improved at2weeks and1year after operation,and the differences were statistically significant(P<0.05);the correction rate of scoliosis was79.2%in group A and81.4%in group B,and the difference was not statistically significant(P>0.05).There was no significant difference in the degree of rotation between the2groups at pre-operation(P>0.05);the derotation degree of the apical vertebra in group B was better than that in group A at postoperative2weeks and1year,and the differences were statistically significant(P<0.05).Conclusion Both kinds of pedicle screw are effective in correcting coronal deformity of lenke5AIS.However,the uniplanar pedicle screw is more effective in derotation of apical vertebrae.