大于90°的重度脊柱侧凸患者的单纯后路椎弓根螺钉内固定治疗

研究设计回顾性比较研究。目的评估单纯后路椎弓根螺钉内固定治疗侧凸角度＞90°的重度脊柱畸形的疗效和安全性。研究背景对于侧凸角度＞90°的重度脊柱畸形的标准手术方式仍存争议，传统术式包括围手术期牵引辅助和分期前后路联合手术。方法回顾性分析由同一术者采取单纯后路椎弓根螺钉内固定治疗的40例侧凸角度＞90°的重度脊柱畸形患者资料，侧凸角度平均为111.4°（91～175）°，平均随访31（6～60）个月。其中特发性脊柱侧凸27例，先天性9例，神经肌肉型3例，症状性1例。40例中，25例行多节段Ponte截骨术联合后路椎弓根螺钉内固定术，另15例则行全脊椎切除联合后路椎弓根螺钉内固定术。分析影像学结果和并发症发生率。结果影像学结果表明，单纯后路椎弓根螺钉矫形术可使主弯平均矫正率术后8周达49%，而末次随访时为47%（P＜0.001）。总畸形角度（主弯Cobb’s角＋最大后凸角）术前平均为160°，而术后8周和末次随访时，平均矫正率分别为50%和48%（P＜0.001）。有7例（18%）术中运动诱发电位（motorevokedpotential，MEP）消失，而4例（10%）术后出现暂时性脊髓神经损伤。1例术后并发伤口感染。另1例术后2年随访时发现内植物断裂，予以观察随访。结论单纯后路椎弓根螺钉内固定可有效治疗角度＞90°的重度脊柱侧凸，其可避免前路手术或围手术期牵引，达到理想的矫形效果，且无严重并发症。

Posterior only pedicle screw construct for the treatment of scoliotic curves greater than 90 degrees

Study design A retrospective comparative study. Objective To assess the efifcacy and safety of posterior only pedicle screw construct （ POPS ） for the treatment of scoliotic curves〉90 degrees using radiographic outcomes and various clinical outcomes. Summary of Background Data A paucity of data exists regarding standardized surgical options for severe scoliotic curvatures 〉 90°. Perioperative traction or staged anterior and posterior operations were the traditional surgical options. Methods A total of 40 consecutive scoliosis patients with curves〉90° （ average 111.4°;range 91°-175° ） with an （ average follow-up of 31 months;range 6-60 months ） who underwent spinal instrumented fusion with posterior only pedicle screw constructs performed by a single surgeon were analyzed. Diagnoses included idiopathic scoliosis （ n=27 ）, congenital （ n=9 ）, neuromuscular （ n=3 ）, and syndromic （ n=1 ）. In total, 25 patients were treated with posterior only pedicle screw constructs with multiple Ponte ostotomies while the other 15 patients with posterior vertebral column resection. Radiographic examinations and complications were analyzed. Results Radiographic outcomes demonstrated an average major curve correction of 49%and 47%at eight weeks post operation and final follow-up respectively （ P90 degree can be managed successfully by posterior only pedicle screw construct （ POPS ）. POPS avoids the need for anterior surgical procedures or perioperative＆nbsp;traction while achieving acceptable correction safely without signiifcant complication.