Rotational Changes of the Vertebral Pelvic Axis After Sublaminar Instrumentation in Adolescent Idiopathic Scoliosis
Rotational Changes of the Vertebral Pelvic Axis After Sublaminar Instrumentation in Adolescent Idiopathic Scoliosis
复制标题
青少年特发性脊柱侧弯椎板下固定后椎体骨盆轴的旋转变化
DOI：
10.1097/00007632-199701010-00009
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发表时间：
1997
期刊：
影响因子：
3
通讯作者：
Munish C. Gupta
中科院分区：
文献类型：
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作者：
K. Wood;John M. Olsewski;M. Schendel;O. Boachie;Munish C. Gupta
研究设计 作者研究了 20 名接受青少年特发性脊柱侧凸治疗的患者的椎板下布线对脊柱骨盆轴的旋转效应。目的 确定椎板下布线是否能有效扭转脊柱侧凸。背景数据总结 通过层下布线矫正青少年脊柱侧弯的旋转畸形在文献中尚未得到很好的量化。 Cotrel-Dubousset 的反旋转操作已被证明会产生可变且不可预测的轴向反旋转量。方法对20例因青少年特发性脊柱侧凸而接受后路脊柱融合术的患者进行术前、术后及后续随访检查（平均随访时间为术后35个月）的计算机断层扫描和平片评估。在手术前后以及随访检查时测量椎体绕矢状面的旋转角度以及相对于骨盆的旋转角度。结果 相对于采用层下布线的骨盆，初级胸椎曲线并未显着扭转。用椎弓根螺钉固定在凸面上的初级胸腰椎曲线相对于骨盆显着扭转（P =.001）。平均初始修正率为 57%。在最终的随访检查中，矫正率为 24%（20 名 20 人中有 18 人的轴向矫正平均丢失了 34%）。 20 名患者中有 9 名的脊柱相对于骨盆的旋转程度比手术前更大。在任何曲线类型中均未发现冠状或矢状失代偿。结论 使用层下器械可以实现脊柱侧弯的冠状面和矢状面矫正。然而，轴向扭转脊柱侧弯的能力似乎是可变的，并且在大多数情况下，取决于曲线类型。随着时间的推移，很多矫正似乎都消失了，许多患者的脊柱侧弯实际上变得比手术前更严重。尽管如此，发生的心尖去旋转似乎是相当真实的：围绕矢状平面的旋转角度的校正百分比和围绕矢状平面相对于骨盆的旋转角度的校正百分比密切相关。施加到仪器化脊柱上的反旋转力似乎不会传递到更远端的节段。
Study Design The authors studied the rotational effect of sublaminar wiring on the spinal pelvic axis on 20 patients who were being treated for adolescent idiopathic scoliosis. Objectives To determine if sublaminar wiring effectively derotates the scoliotic spine. Summary of Background Data The correction of the rotational deformity in adolescent scoliosis via sublaminar wiring is not well quantified in the literature. The derotation maneuver of Cotrel‐Dubousset has been shown to produce variable and unpredictable amounts of axial derotation. Methods Twenty patients who underwent posterior spine fusion for adolescent idiopathic scoliosis were evaluated using computed tomography scans and plain radiography before and after surgery and at a subsequent follow‐up examination (average time of follow‐up examination, 35 months after surgery). The degree of angle of vertebral rotation about the sagittal plane and that relative to the pelvis were measured before and after surgery and at a follow‐up examination. Results The primary thoracic curves were not derotated significantly relative to the pelvis with sublaminar wiring. Primary thoracolumbar curves instrumented on the convexity with pedicle screws were derotated significantly relative to the pelvis (P =.001). The average initial correction was 57%. On final follow‐up examination, the correction was 24% (18 of 20 twenty individuals lost axial correction by an average of 34%). In nine of 20 patients the spine was more rotated, relative to the pelvis, than it had been before surgery. No coronal or sagittal decompensation was seen in any curve type. Conclusions Coronal and sagittal plane correction of scoliotic curves may be achieved with sublaminar instrumentation. The ability to derotate axially the scoliotic spine appears to be variable, however, and, in most cases, curve‐type dependent. Over time, much correction appears to be lost, and in many patients the scoliosis actually becomes worse than it was before surgery. Nonetheless, the apical derotation that takes place appears to be reasonably true: the percent correction of angle of rotation about the sagittal plane and the percent correction of angle of rotation about the sagittal plain relative to the pelvis were closely correlated. Derotation forces applied to the instrumented spine do not appear to be transmitted to more distal segments.