Ponte osteotomies to treat major thoracic adolescent idiopathic scoliosis curves allow more effective corrective maneuvers
Ponte osteotomies to treat major thoracic adolescent idiopathic scoliosis curves allow more effective corrective maneuvers
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DOI：
10.1007/s00586-014-3749-1
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发表时间：
2015-07-01
影响因子：
2.8
通讯作者：
Izquierdo, Enrique
中科院分区：
文献类型：
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作者：
Pizones, Javier;Sanchez-Mariscal, Felisa;Izquierdo, Enrique
对于青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者，Ponte截骨术在改善冠状面矫正、随访期间维持冠状面矫正以及恢复胸椎后凸方面的效果存在争议。回顾性比较了43例接受心尖Ponte截骨术和椎板下钢丝（使用混合器械）的连续患者与30例未接受“Ponte截骨术”的患者的历史队列。记录手术细节和并发症。我们对2年随访期间的影像学测量和SRS-22问卷评分进行了评估。Ponte组术后（70 vs 57%）和最终（62 vs 50%）主曲线矫正率均较好（P < 0.001），最终随访（48 vs 106个月）时矫正率无显著损失（4.2A度vs 2.5A度）P = 0.2。我们没有发现胸椎（T5-T12）术后（22 A度vs 24 A度）和最终（25 A度vs 26 A度）平均后凸角的差异。然而，“Ponte截骨术”有助于获得正常的矢状面，增加术前后凸曲线（< 10A度）从6A度到17 A度（对照组：9A度aEuro“12 A度; P = 0.01）;术前过度后凸曲线（> 40 A度）从52 A度到26 A度（对照组：46 A度aEuro“39 A度; P = 0.01）。手术时间相似（4.3 vs 4.6 h），SRS-22评分也相似。没有发现严重的并发症。通过椎板下钢丝治疗的主要胸椎AIS曲线的Ponte截骨术允许更有效的矫正操作，这改善了冠状面矫正，在随访期间没有明显损失。矢状面轮廓似乎是由其他变量决定的;然而，“Ponte截骨术”有助于塑造所需的脊柱后凸。
There is controversy regarding the effect of the Ponte osteotomies in the improvement of coronal correction, its maintenance during follow-up, and the restoration of thoracic kyphosis in adolescent idiopathic scoliosis (AIS).Seventy-three AIS patients with Lenke type 1-4 curves were included. A prospective description of 43 consecutive patients who underwent apical Ponte osteotomies and sublaminar wires with hybrid instrumentation was retrospectively compared to a historical cohort of 30 patients without "Ponte osteotomies". The surgical details and complications were recorded. We evaluated the radiological measurements and SRS-22 Questionnaire scores over a 2-year follow-up.The Ponte group achieved better postoperative (70 vs 57 %) and final (62 vs 50 %) main curve correction P < 0.001, with no significant loss of correction (4.2A degrees vs 2.5A degrees) P = 0.2 at the final follow-up (48 vs 106 months). We did not find a difference in thoracic (T5-T12) postoperative (22A degrees vs 24A degrees) and final (25A degrees vs 26A degrees) mean kyphosis angle. However, the "Ponte osteotomies" helped to achieve a normal sagittal profile, increasing preoperative hypokyphotic curves (< 10A degrees) from 6A degrees to 17A degrees (control: 9A degrees aEuro"12A degrees; P = 0.01); and preoperative hyperkyphotic curves (> 40A degrees) from 52A degrees to 26A degrees (control: 46A degrees aEuro"39A degrees; P = 0.01). The length of surgery was similar (4.3 vs 4.6 h), as were the SRS-22 scores. No major complications were found.Ponte osteotomies in major thoracic AIS curves treated by sublaminar wires allowed more effective corrective maneuvers, which improved coronal correction without a significant loss during follow-up. The sagittal profile appears to be determined by other variables; however, "Ponte osteotomies" facilitate the contouring of the desired kyphosis.