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

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间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.

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

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 leveis 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.