王超;张国友;李明;朱晓东;白玉树;魏显招;王传锋;赵颖川;

• 1:第二军医大学长海医院骨科

摘要(Abstract)：

[目的]评估对具有良好柔韧性的特发性脊柱侧凸患者采用椎弓根螺钉间隔置钉三维矫形术后随访5年以上手术疗效。[方法]对51例侧凸角度<75°,柔韧度>40%的特发性脊柱侧凸患者,采用椎弓根螺钉间隔置钉三维矫形,分析术前、术后即刻及末次随访时主弯侧凸Cobb角、顶椎旋转、冠状面平衡、矢状面平衡及手术时间、术中失血量、并发症等。[结果]主胸弯侧凸Cobb角由术前(53.6±6.6)°矫正为(15.8±7.4)°,末次随访为(17.7±6.1)°;顶椎旋转由术前(21.4±7.1)°矫正为(9.6±3.0)°,末次随访时为(11.0±3.3)°;冠状面C7铅垂线与骶正中线距离术前、术后即刻及末次随访分别为(-6.3±11.2)mm、(-3.7±8.0)mm、(-3.9±5.5)mm;矢状面C7铅垂线与S1椎体后上缘距离术前、术后即刻及末次随访分别为(-13.3±10.7)mm、(-2.1±5.2)mm、(-2.9±5.0)mm。患者侧凸Cobb角、顶椎旋转、冠状面及矢状面平衡术前、术后比较差异均有统计学意义(P<0.05),末次随访与术后相比差异无统计学意义(P>0.05)。术后2例内固定失败,3例出现远端延长现象,1例发生伤口表浅感染。术中平均失血量为825 ml,手术时间为155 min。与常规手术方式相比,本组患者椎弓根螺钉置钉数量减少52%。[结论]对于良好柔韧性的特发性脊柱侧凸患者,采用椎弓根螺钉间隔置钉可获得良好的矫形效果,并具有缩短手术时间、减少术中失血、节省手术费用等优点。

关键词(KeyWords)： 特发性脊柱侧凸;间隔置钉;椎弓根螺钉;三维矫形

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王超;张国友;李明;朱晓东;白玉树;魏显招;王传锋;赵颖川;

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参考文献(References)：

• [1]Dede O,Ward WT,Bosch P,et al.Using the freehand pedicle screw placement technique in adolescent idiopathic scoliosis surgery:what is the incidence of neurological symptoms secondary to misplaced screws[J].Spine(Phila Pa 1976),2014,4:286-290.
• [2]Allam Y,Silbermann J,Riese F,et al.Computer tomography assessment of pedicle screw placement in thoracic spine:comparison between free hand and a generic 3D-based navigation techniques[J].Eur Spine J,2013,3:648-653.
• [3]Crostelli M,Mazza O,Mariani M.Free-hand pedicle screws insertion technique in the treatment of 120 consecutive scoliosis cases operated without use of intraoperative neurophysiological monitoring[J].Eur Spine J,2012,1:43-49.
• [4]Cao Y,Xiong W,Li F.Pedicle screw versus hybrid construct instrumentation in adolescent idiopathic scoliosis:meta-analysis of thoracic kyphosis[J].Spine(Phila Pa 1976),2014,13:800-810.
• [5]Jaquith BP,Chase A,Flinn P,et al.Screws versus hooks:implant cost and deformity correction in adolescent idiopathic scoliosis[J].J Child Orthop,2012,2:137-143.
• [6]Perdriolle R,Vidal J.Morphology of scoliosis:three-dimensional evolution[J].Orthopedics,1987,6:909-915.
• [7]Hwang SW,Samdani AF,Marks M,et al.Five-year clinical and radiographic outcomes using pedicle screw only constructs in the treatment of adolescent idiopathic scoliosis[J].Eur Spine J,2013,6:1292-1299.
• [8]Crawford AH,Lykissas MG,Gao X,et al.All-pedicle screw versus hybrid instrumentation in adolescent idiopathicscoliosis surgery:a comparative radiographical study with a minimum 2-year follow-up[J].Spine(Phila Pa 1976),2013,14:1199-1208.
• [9]Fu G,Kawakami N,Goto M,et al.Comparison of vertebral rotation corrected by different techniques and anchors in surgical treatment of adolescent thoracic idiopathic scoliosis[J].J Spinal Disord Tech,2009,3:182-189.
• [10]Yilmaz G,Borkhuu B,Dhawale AA,et al.Comparative analysis of hook,hybrid,and pedicle screw instrumentation in the posterior treatment of adolescent idiopathic scoliosis[J].J Pediatr Orthop,2012,5:490-499.
• [11]Samdani AF,Ranade A,Sciubba DM,et al.Accuracy of free-hand placement of thoracic pedicle screws in adolescent idiopathic scoliosis:how much of a difference does surgeon experience make[J].Eur Spine J,2010,1:91-95.
• [12]Abe Y,Ito M,Abumi K,et al.A novel cost-effective computer-assisted imaging technology for accurate placement of thoracic pedicle screws[J].J Neurosurg Spine,2011,5:479-485.
• [13]Kotani T,Akazawa T,Sakuma T,et al.Accuracy of pedicle screw placement in scoliosis surgery:a comparison between conventional computed tomography-based and o-arm-based navigation techniques[J].Asian Spine J,2014,3:331-338.
• [14]Sudo H,Ito M,Abe Y,et al.Surgical treatment of Lenke 1 thoracic adolescent idiopathic scoliosis with maintenance of kyphosis using the simultaneous double-rod rotation technique[J].Spine(Phila Pa1976),2014,14:1163-1169.
• [15]Sun Z,Qiu G,Zhao Y,et al.Lowest instrumented vertebrae selection for selective posterior fusion of moderate thoracolumbar/lumbar idiopathic scoliosis:lower-end vertebra or lower-end vertebra[J].Eur Spine J,2014,6:1251-1257.
• [16]Suk SI,Kim JH,Cho KJ,et al.Is anterior release necessary in severe scoliosis treated by posterior segmental pedicle screw fixation[J].Eur Spine J,2007,9:1359-1365.
• [17]Bharucha NJ,Lonner BS,Auerbach JD,et al.Low-density versus high-density thoracic pedicle screw constructs in adolescent idiopathic scoliosis:do more screws lead to a better outcome[J].Spine J,2013,4:375-381.
• [18]Chen J,Yang C,Ran B,et al.Correction of Lenke 5 adolescent idiopathic scoliosis using pedicle screw instrumentation:does implant density influence the correction[J].Spine(Phila Pa 1976),2013,15:946-951.
• [19]Wang Y,Bünger CE,Zhang Y,et al.Distal adding-on in Lenke 1A scoliosis:how to more effectively determine the onset of distal adding-on[J].Spine(Phila Pa 1976),2013,6:490-495.
• [20]Di Silvestre M,Lolli F,Bakaloudis G,et al.Apical vertebral derotation in the posterior treatment of adolescent idiopathic scoliosis:myth or reality[J].Eur Spine J,2013,2:313-323.
• [21]Yagi M1,King AB,Boachie-Adjei O.Incidence,risk factors,and natural course of proximal junctional kyphosis:surgical outcomes review of adult idiopathic scoliosis.Minimum 5 years of follow-up[J].Spine(Phila Pa 1976),2012,17:1479-1489.
• [22]Divecha HM,Siddique I,Breakwell LM,et al.Complications in spinal deformity surgery in the United Kingdom:5-year results of the annual British Scoliosis Society National Audit of Morbidity and Mortality[J].Eur Spine J,2014,1:55-60.
• [23]Sugarman E,Sarwahi V,Amaral T,et al.Comparative analysis of perioperative differences between hybrid versus pedicle screw instrumentation in adolescent idiopathic scoliosis[J].J Spinal Disord Tech,2013,3:161-166.
• [24]Cho SK,Bridwell KH,Lenke LG,et al.Comparative analysis of clinical outcome and complications in primary versus revision adult scoliosis surgery[J].Spine(Phila Pa 1976),2012,5:393-401.
• [25]Takahashi J,Hirabayashi H,Hashidate H,et al.Accuracy of multilevel registration in image-guided pedicle screw insertion for adolescent idiopathic scoliosis[J].Spine(Phila Pa 1976).2010,3:347-352.