Ponte截骨与SPO截骨联合后路全椎弓根螺钉系统矫正僵硬性青少年特发性胸椎侧凸的疗效比较

目的]对Ponte截骨与Smith-Petersen截骨(SPO截骨)治疗僵硬性青少年特发性胸椎侧凸的临床疗效及影像学结果进行回顾性比较。方法]2007年5月～2009年3间收治的单纯后路全椎弓根螺钉系统矫正僵硬性青少年特发性胸椎侧凸的手术病例58例,其中36例行SPO截骨,22例行Ponte截骨。通过影像学检查对两组的手术效果和躯干平衡情况进行分析,末次随访时用中文版SRS-22量表进行患者的健康生存质量评价。结果]两组患者的性别比例、手术时年龄、Risser征、融合节段数、置钉密度、术前冠状面胸主弯Cobb角无显著性意义(P>0.05)。Ponte截骨组的术后3个月冠状面胸主弯Cobb角矫正率明显大于SPO截骨组,分别为67.1%和56%(P<0.05)。末次随访时两组矫正率得到很好的维持,分别为61%和50.5%(P<0.05)。两组的术前、术后腰椎代偿性次弯Cobb角无显著性差异。两组的术前胸椎后凸Cobb角分别为20.6±8.5°和22.3±10.5°,术后3个月胸椎后凸角SPO截骨组比术前平均增加1.2°,Ponte截骨组比术前平均丢失1.4°,末次随访SPO截骨组胸椎后凸角比术前平均增加1.9°,Pon-te截骨组比术前平均丢失2.9°,两组间比较无显著性差异(P>0.05)。两组的次要并发症无显著性差异(P>0.05),两组均未发生主要并发症。结论]多节段Ponte截骨能提高僵硬性青少年特发性胸椎侧凸冠状面胸主弯Cobb角的手术矫正率,并不增加并发症的发生率,而且能提供更多的局部自体植骨量、增加植骨融合面积。

Surgical treatment of rigid adolescent thoracic idiopathic scoliosis with posterior all pedicle screw constructs:comparison of Ponte osteotomy versus Smith-Petersen osteotomy

Objective]To compare the clinical and radiological outcomes between Ponte osteotomy and Smith-Petersen osteotomy(SPO)for the surgical treatment of rigid adolescent thoracic idiopathic scoliosis with posterior all pedicle screw constructs. Methods]From May 2007 to March 2009,58 patients with rigid adolescent thoracic idiopathic scoliosis were treated by posterior segmental pedicle screw instrumentation and polysegmental osteotomy were analyzed retrospectively.Ponte osteotomy group consisted of 22 patients and Smith-Petersen osteotomy group consisted of 36 patients.Preoperative and postoperative Cobb angles of coronal plane and sagittal plane and trunk balance were analyzed.Health-related quality of life were assessed by Chinese version of SRS-22 questionnaire at final follow-up. Results]There was no difference in sex,age at surgery,Risser sign,instrumented level,impant density,and preoperative thoracic main curve Cobb angle between the two groups(P>0.05).The correction rate of thoracic main curve at 3 months after surgery were 67.1% in Ponte group and 56% in SPO group.The amout of thoracic main curve correction in Ponte group were significantly greater than that in SPO group(P<0.05),and maitained at final follow-up(61% vs.50.5%,P<0.05).Preoperative and postoperative lumbar secondary curves were similar in both the groups.Preoperative thoracic kyphosis were 20.6±8.5° in Ponte group and 22.3±10.5° in SPO group.The degrees corrected at 3 months after surgery(-1.4° in Ponte group vs.+1.2° in SPO group) and at final follow-up(-2.9° in Ponte group vs.+1.9° in SPO group),were not statistically different(P>0.05).Minor complications were similar in both groups and no major complications were found. Conclusion]Ponte osteotomy at multiple levels improves coronal thoracic main curve correction in patients with rigid adolescent thoracic idiopathic scoliosis,without an increase in the incidence of complications.Furthermore,it provides more local bone graft and improves fusion surface.