Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis - More than 5-year follow-up
Selective thoracic fusion with segmental pedicle screw fixation in the treatment of thoracic idiopathic scoliosis - More than 5-year follow-up
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DOI：
10.1097/01.brs.0000169452.50705.61
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发表时间：
2005-07-15
期刊：
影响因子：
3
通讯作者：
Kim, SS
中科院分区：
文献类型：
--
作者：
Suk, SI;Lee, SM;Kim, SS
研究设计.回顾性研究。通过至少5年的随访，评价选择性胸椎融合联合节段椎弓根螺钉固定治疗胸椎特发性脊柱侧凸的结局。节段椎弓根螺钉固定已被证明能够实现真正的节段控制，并在脊柱侧凸的冠状面和矢状面实现更大的矫正。然而，对于胸椎特发性脊柱侧凸患者，选择性胸椎融合联合节段椎弓根螺钉内固定的长期研究尚不多见。分析了203例胸椎特发性脊柱侧凸患者的236个胸椎弯曲，这些患者接受了节段椎弓根螺钉固定的选择性胸椎融合术。手术时患者平均年龄为13.8岁（范围：8.9-18岁）。在最近的随访中，术前51 +/- 12度的胸椎弯曲矫正至16 +/- 7度（69%矫正，3%矫正丢失）。在最近的随访中，30 +/- 10度的非内固定腰椎弯曲被矫正为10 +/- 8度（66%矫正，5%矫正丢失）。术前胸椎后凸为18 +/- 11度，腰椎前凸为43 +/- 10度，在最近的随访中分别改善至23 +/- 8度和46 +/- 9度。在最近的随访中没有交界性脊柱后凸。在最近的随访中，10名患者发生冠状动脉失代偿。17例患者发生术后附加，融合距离中立椎两个节段。在2，867枚胸椎椎弓根螺钉中，发现43枚螺钉错位（1.5%），但未引起神经系统并发症或对长期结果产生不良影响。选择性胸椎融合联合节段性椎弓根螺钉固定治疗胸椎特发性脊柱侧凸，术后影像学和临床结局令人满意，并在至少5年的随访中保持良好。该方法安全、有效，可保留腰椎活动节段，恢复和维持冠状位和矢状位的排列。
Study Design. Retrospective study.Objectives. To evaluate outcomes of selective thoracic fusion with segmental pedicle screw fixation in thoracic idiopathic scoliosis with a minimum 5-year follow-up.Summary of Background Data. Segmental pedicle screw fixation has been proven to enable true segmental control and greater correction both in coronal and sagittal planes of scoliosis. However, there is no long-term study of selective thoracic fusion with segmental pedicle screw fixation in thoracic idiopathic scoliosis.Methods. Two hundred and three thoracic idiopathic scoliosis patients with 236 thoracic curves subject to selective thoracic fusion with segmental pedicle screw fixation were analyzed. Mean patient age at the time of operation was 13.8 years ( range: 8.9-18).Results. The preoperative thoracic curve of 51 +/- 12 degrees was corrected to 16 +/- 7 degrees (69% correction, 3% loss of correction) at the most recent follow-up. The noninstrumented lumbar curve of 30 +/- 10 degrees was corrected to 10 +/- 8 degrees (66% correction, 5% loss of correction) at the most recent follow-up. The preoperative thoracic kyphosis of 18 +/- 11 degrees and the lumbar lordosis of 43 +/- 10 degrees were improved to 23 +/- 8 degrees and 46 +/- 9 degrees, respectively, at the most recent follow-up. There was no junctional kyphosis at the most recent follow- up. Coronal decompensation at the most recent follow- up occurred in 10 patients. Postoperative adding-on occurred in 17 patients, who were fused two levels short of the neutral vertebra. Of the 2,867 thoracic pedicle screws inserted in the thoracic level, 43 screws were found to be malpositioned ( 1.5%), but they did not cause neurologic complications or adversely affect the long-term results.Conclusions. Selective thoracic fusion with segmental pedicle screw fixation in thoracic idiopathic scoliosis had satisfactory radiographic and clinical outcomes after surgery and has been well-maintained for minimum 5-year follow- up. It is a safe and effective method for preservation of lumbar motion segments as well as for restoration and maintenance of both coronal and sagittal alignment.