TSRH器械在特发性脊柱侧凸中的应用

[目的]观察TSRH三维矫形系统矫正特发性脊柱侧凸冠状面、矢状面和轴状面的疗效,评价应用钉棒系统和钉钩棒系统随访时的效果。[方法]分析采用TSRH系统治疗特发性脊柱侧凸79例,男48例,女31例,平均15.5岁。全部应用椎弓根螺钉系统56例,胸椎应用椎弓根钩或椎板钩,腰椎应用椎弓根螺钉23例。对照分析2组的矫正效果。[结果]术后冠状位矫正为18~31°,矫正率为56%~87%,平均为68%,矢状位矫正为21~33°,平均25°,旋转矫正Ⅰ度。身高平均增高3 cm。63例平均随访2.5 a,2组冠状面和矢状面的矫正率以及冠状面矫正度的丢失有明显的差异。[结论]TSRH矫形系统治疗脊柱侧凸可得到满意的治疗效果,应用椎弓根螺钉效果更佳。     

全节段椎弓根螺钉与椎弓根钉、钩系统矫治单胸弯特发性脊柱侧凸的疗效比较

目的：比较全节段椎弓根螺钉与椎弓根钉、钩系统固定治疗单胸弯青少年特发性脊柱侧凸（AIS）患者的效果。方法：2002年5月-2003年10月治疗24例单胸弯AIS患者，12例采用全节段胸椎弓根螺钉固定技术进行脊柱畸形的矫正（A组）；12例采用腰或胸腰段椎弓根螺钉＋胸椎钩系统固定矫正畸形（B组）。记录两组的手术时间、失血量和并发症；同时进行影像学检查评价矫形效果；术前、术后及末次随访时行肺功能测试和SRS-24评分。结果：平均手术时间分别为256min（A组）和262min（B组），平均术中失血量分别为735ml（A组）和812ml（B组），均无明显差异；两组均没有出现神经性损害。手术后在冠状面和矢状面上A组胸弯矫正率79．6％；B组胸弯矫正率66．5％，存在显著性差异。A组平均融合10．6个椎体，较B组平均节省了0．8个椎体。术后4年随访时，A组FvC较术前增加0．23L，B组增加0．12L，但组间不存在统计学差异；A组SRS-24评分平均为101，B组平均为108，两组间无明显差异。结论：相对于传统钉钩系统，全节段胸椎弓根螺钉技术可以在更短的固定融合范围内取得并维持更为理想的三维矫正效果。     

椎板钩和椎弓根钉系统治疗特发性脊柱侧凸后侧矫正与融合术的比较分析

目的：对椎板钩和椎弓根钉系统治疗特发性胸椎侧凸后侧矫正和融合术的临床结果进行比较分析。并探讨脊柱椎弓根钉系统在外科治疗脊柱侧凸中是否安全，是否可以矫正出更好的曲线，是否要求更短的融合。方法：对50例特发性脊柱侧凸的病人用椎弓根钉和椎板钩治疗后，分析他们的矫正曲线，融合长度以及并发症发生率。25例病人采用椎板钩的系统手术，称椎板钩组；25例病人采用两种术式，上胸段椎板钩下胸段和腰段椎弓根钉联合术式或者完全用椎弓根钉系统手术，称椎弓根钉组。结果：在随后的(1～8年)曲线校正中椎弓根钉组达到50．1％(P=0．001)，明显好于椎板钩组的41．1％。依据Perdriolle标准，两组对脊椎尖端的旋转都矫正甚微，椎板钩矫正了42．0％，椎弓根钉矫正了55．6％。对矢状面畸形的矫正两个组没有区别。融合长度椎弓根钉组较椎板钩组平均少0．6个锥体。结论：椎弓根钉组在矫正侧弯的角度等方面明显好于椎板钩组。     

椎板钩和椎弓根钉系统治疗脊柱侧凸病例对照研究

目的 探讨脊柱椎弓根钉系统治疗脊柱侧凸是否安全．是否可以矫正出更好的曲线，是否能达到更短节段的融合。方法 50例特发性脊柱侧凸患者中15例采用椎板钩系统手术(椎板钩组)，25例采用上胸段椎板钩、下胸段和腰段椎弓根钉联合术式或者完全川椎弓根钉系统手术(椎弓根钉组)比较两组矫正曲线、融合长度以及并发症发生率。结果 随访1～8年，曲线校正：椎弓根钉组达50．1％，明显好于椎板钩组的41.1％。矢状面畸形的矫正：两组没有区别融合长度：椎弓根钉组较椎板钩组平均少0．6个锥体。结论 椎弓根钉组在矫正侧凸的角度等方面明显好于椎板钩组。     

后路减压全节段椎弓根钉棒固定治疗退行性脊柱侧凸

目的探讨采用椎管减压、全节段椎弓根钉棒系统治疗退行性脊柱侧凸的临床效果。方法总结31例退行性脊柱侧凸患者,采用后路椎管减压、椎间Vigor植入、全节段椎弓根钉棒矫形内固定、后外侧植骨融合术治疗。结果平均随访1.5年,31例患者腰椎侧凸矫形良好、腰椎生理前凸恢复满意,神经功能恢复。结论后路减压全节段椎弓根螺钉系统可达到矫形、固定、重建脊柱稳定的目的,有利于退行性脊柱侧凸患者腰背痛及神经根性症状的改善。     

采用关键椎置钉及选择性融合治疗Lenke6型AIS可行性的有限元分析

[目的]通过有限元模型矫形手术模拟的方法探讨关键椎置钉技术的可行性及矫形效果,分析Lenke 6型脊柱侧凸是否适合采用选择性融合策略.[方法]通过CT图像建立1例Lenke 6型特发性脊柱侧凸三维有限元模型,并验证其有效性后,利用后路CD矫形手术模拟技术,分别模拟全节段椎弓根钉技术矫形工况、关键椎置钉技术矫形工况、胸腰弯选择性融合工况等.测量各种工况完成后双弯Cobb角度、计算矫形率,分析各种工况的矫形效果.[结果]全节段椎弓根钉技术(非选择性融合):胸腰弯矫形率47.8％,主胸弯矫形率43.9％;关键椎置钉技术:胸腰弯矫形率44.2％,主胸弯矫形率19.1％;胸腰弯选择性融合:胸腰弯矫形率43.5％,主胸弯矫形率14.3％.[结论]全节段椎弓根钉技术因矫形力施加点更多,矫形效果较关键椎置钉技术更佳;Lenke 6型脊柱侧凸采用选择性融合策略应慎重,非选择性融合策略能明显矫正双弯,纠正脊柱序列,更适合该类型病例.     

椎弓根螺钉固定系统对特发性脊柱侧凸矫正效果的影响

目的:探讨经椎弓根螺钉固定对特发性脊柱侧凸矫正效果的影响。方法:66例特发性脊柱侧凸患者分别采用钩-棒、钩-钉-棒或钉-棒固定的方法进行矫正,对各组患者的一般情况、畸形程度、矫正效果和并发症进行分析比较。结果:各组在畸形程度、手术时间以及手术并发症等无显著性差异,椎弓根钉-棒固定组在冠状面和矢状面的矫正率和维持矫正效果均较钩-棒或钩-钉-棒固定组明显提高。结论:在不增加并发症的前提下,椎弓根螺钉固定可以提高特发性脊柱侧凸的手术矫正效果。     

全椎弓根螺钉与钉钩联合系统治疗青少年Chiari畸形伴胸椎侧凸的疗效比较

 目的 评估青少年Chiari畸形伴胸椎侧凸不同内固定模式的选择对手术疗效的影响。 方法 回顾性分析2001年3月至2011年3月期间,接受后路胸椎融合术的75例Chiari畸形伴脊柱侧凸患者的病历资料,根据内固定方式分为全椎弓根螺钉组(44例)和钉钩联合组(31例)。分别测量术前、术后以及末次随访时的影像学指标：冠状面侧凸Cobb角、侧凸柔韧性、顶椎偏移、顶椎旋转及躯干偏移;矢状面胸椎后凸角、腰椎前凸角、躯干偏移及近端与远端交界区Cobb角。比较两组术前、术后及末次随访时上述影像学指标的改变。根据术前不同程度胸椎后凸进一步分组,比较两种内固定模式的手术疗效。结果 全椎弓根螺钉组术后胸弯平均矫正率为60.2％,明显著高于钉钩联合组(51.3％,t=2.372,P=0.023)。末次随访时全椎弓根螺钉组及钉钩联合组胸弯矫正丢失率分别为0.3％及1.7％(t=-0.468,P >0.05)。术后腰弯平均矫正率在全椎弓根螺钉组为61.7％,明显优于钉钩联合组51.1％(t=2.431,P=0.020)。术前全椎弓根螺钉组与钉钩联合组的胸弯顶椎偏移分别平均为25.0 mm和24.1 mm,术后减小至6.9 mm和7.4 mm,两组术后的胸弯顶椎偏移均获得明显改善。术前胸椎后凸>40°的病例中,全椎弓根螺钉组末次随访时矢状面近端交界区Cobb角为10.0°,高于钉钩联合组(4.5°,t=-2.031,P=0.052)。而且全椎弓根螺钉组近端交界性后凸发生率(20% )高于钉钩联合组(9%)。结论 对继发于青少年Chiari畸形的胸椎侧凸行后路内固定矫形,全椎弓根螺钉具有更好的畸形矫正率,但是,与钉钩联合固定相比,术前胸椎过度后凸的患者在胸椎全椎弓根螺钉固定术后远期发生近端交界性后凸的风险增高。     

顶椎凹侧置钉类型对青少年特发性脊柱侧凸患者矫形效果的影响

目的：探讨顶椎凹侧置钉类型对青少年特发性脊柱侧凸（AIS）患者矫形效果的影响。方法：2002年1月-2007年10月采用全节段椎弓根螺钉固定技术治疗83例单结构弯的AIS患者，年龄13．5，17岁．平均15．5岁。根据顶椎凹侧置钉种类不同分为：顶椎单轴向螺钉固定组（A组，38例）和多轴向螺钉固定组（B组，45例）。两组术前Cobb角、柔韧性、顶椎旋转度无明显统计学差异。比较两组的Cobb角矫正率和顶椎去旋转率（RAsag角矫正率），并根据CT上螺钉长轴与钉帽轴线的夹角大小和方向来判断B组顶椎钉口成角程度和方向。结果：两组Cobb角矫正率无明显统计学差异（69％、68％，P〉0．05），A组顶椎去旋转率高于B组（42％、34％，P〈0．05）。术后CT证实B组的顶椎凹侧有37枚螺钉（82％）出现钉口成角（平均-13．5^o）。结论：单轴向螺钉的顶椎去旋转率明显高于多轴向螺钉。对于单结构弯。在提高置钉准确性、后方结构充分松解的同时，顶椎凹侧应尽量选择单轴向螺钉固定。     

全节段椎弓根螺钉系统矫治青少年特发性胸腰椎/腰椎侧凸的疗效

目的:探讨采用单纯后路广泛松解技术联合侧凸全节段椎弓根螺钉系统治疗青少年特发性胸腰椎和腰椎脊柱侧凸的疗效。方法:我院于2002年4月至2005年7月连续收治了114例(女86例,男28例)青少年特发性胸腰椎和腰椎脊柱侧凸患者,其中Lenke5型72例,Lenke6型32例,Lenke3C型10例。全部采用后路广泛松解技术联合椎弓根螺钉系统治疗。手术前后在X线正侧位片上测量冠状位Cobb角,矢状面胸椎后凸角和腰椎前凸角,最下端融合椎冠状面成角,骶骨中垂线与融合下端椎、顶椎及C7中垂线平均距离,并观察各种并发症情况。结果:共置入1460枚椎弓根螺钉,平均融合9.6个椎体(5～14个)。冠状面平均矫正率为78.6%(61°减少到13°),矢状面腰椎前凸角从36°(23°～67°)增加到42°(34°～55°)。最下端融合椎冠状面成角矫正率达79%,骶骨中垂线与融合下端椎距离从2.3cm减少到0.5cm,与顶椎距离从5.0cm缩短到1.6cm;C7中垂线与骶骨中垂线距离由2.7cm减少到0.8cm。术后平均随访时间为30个月(12～50个月),未发现假关节形成、深部感染,且无明显矫形丢失。结论:后路广泛松解联合全节段椎弓根螺钉系统治疗青少年特发性胸腰椎/腰椎侧凸效果满意。     

全椎弓根螺钉与钉钩混合系统治疗青少年特发性脊柱侧凸的疗效分析

目的 通过临床病例回顾,对后路全椎弓根螺钉系统和钉钩混合系统治疗青少年特发性脊柱侧凸的疗效进行对比分析研究.方法 从2000年至2004年进行手术治疗的青少年特发性脊柱侧凸患者中选取60例配对分为两组(A、B两组,各30例),A组采用后路钉钩混合系统固定,B组采用后路全椎弓根螺钉系统固定,配对患者年龄相似、融合节段相仿、Lenke分型相近.通过比较手术前后影像学改变、手术时间、术中出血等,对两种手术方法的疗效进行对比分析研究.结果 A组患者术前冠状面主弯Cobb角平均为61°,术后为25°,平均矫正率为59%;B组患者术前冠状面主弯Cobb角平均为60°,术后为18°,平均矫止率为70%.两组患者主弯矫正率差异有统计学意义(P=0.002),随访2年两组间主弯矫正率差异仍有统计学意义(A、B两组分别为49%、67%,P<0.001).矢状面上,与术前相比,术后2年A组的胸椎后凸角平均减少了1°,而B组则减少了6°,差异有统计学意义(P=0.026).随访结果 提示,两组在下端椎远端融合椎体数、平均失血量方面差异均无统计学意义.两组患者术后均未出现神经系统并发症.结论 全椎弓根螺钉系统较钉钩混合系统能提供更好的主弯矫止率,而在最下端固定椎体的选择、术中失血量方面,两种内固定系统未见明显差异.     

Adolescent idiopathic scoliosis: Retrospective analysis of 235 surgically treated cases

Background:

The surgical treatment of adolescent idiopathic scoliosis (AIS) has taken great strides in the last two decades. There have been no long term reported studies on AIS from India with documented long term followup. In this study we review a single surgical team''s series of 235 surgically treated cases of AIS with a follow-up from two to six years.

Materials and Methods:

Pre operative charts, radiographs and MRI scans for 235 patients were collected for this study. The patients were grouped into three groups where anterior correction and fusion (n=47), posterior correction and fusion (n=123) and combined anterior release and posterior instrumentation (n=65) was performed. Each group was divided into two subgroups based on the surgical approach and instrumentation strategy (all screw construct or hybrid construct) used. Patients were followed up for coronal and saggital plane corrections, apical vertebral translation (AVT), trunk balance and back pain. The percentage of correction was calculated in each group as well as sub groups.

Results:

The incidence of MRI detected intraspinal anomaly in this series is 5.9% with 3.4% of them requiring neurosurgical procedure along with scoliosis correction. Average coronal major curve correction was 66% in the all screw group and 58.5% in the hybrid group. The coronal plane correction was better when the all screw constructs were employed. Also, the AVT and trunk balance was better with the all screw constructs. The anterior corrections resulted in better correction of the AVT and trunk balance as compared to the posterior correction. There were eight (3.4%) complications in this series. The coronal and saggital plane correction paralleled the published international standards.

Conclusion:

The coronal plane correction was better when all screw constructs were employed. Use of all pedicle screw systems obviated the need for costoplasty in most cases. The increased incidence of intraspinal anomaly may warrant a routine pre operative MR imaging of all adolescent scoliosis needing surgical treatment.     

Comparative analysis of pedicle screw and hook instrumentation in posterior correction and fusion of idiopathic thoracic scoliosis

Posterior correction and fusion with segmental hook instrumentation represent the gold standard in the surgical treatment of progressive idiopathic thoracic scoliosis. However, there is a debate over whether pedicle screws are safe in scoliosis surgery and whether their usage might enable a better curve correction and a shorter fusion length. The details of curve correction, fusion length and complication rate of 99 patients with idiopathic thoracic scoliosis treated with either hook or pedicle screw instrumentation were analyzed. Forty-nine patients had been operated with the Cotrel-Dubousset system using hooks exclusively ("hook group"). Fifty patients had been operated with either a combination of pedicle screws in the lumbar and lower thoracic and hooks in the upper thoracic spine or exclusive pedicle screw instrumentation using the Münster Posterior Double Rod System ("screw group"). The preoperative Cobb angle averaged 61.3 degrees (range 40 degrees-84 degrees ) in the hook group and 62.5 degrees (range 43 degrees-94 degrees ) in the screw group. Average primary curve correction was 51.7% in the hook group and 55.8% in the screw group ( P>0.05). However, at follow-up (2-12 years later) primary curve correction was significantly greater ( P=0.001) in the screw group (at 50.1%) compared to the hook group (at 41.1%). Secondary lumbar curve correction was significantly greater ( P=0.04) in the screw group (54.9%) compared to the hook group (46.9%). Correction of the apical vertebral rotation according to Perdriolle was minimal in both groups. Apical vertebral translation was corrected by 42.0% in the hook group and 55.6% in the screw group ( P=0.008). Correction of the tilt of the lowest instrumented vertebra averaged 48.1% in the hook group and 66.2% in the screw group ( P=0.0004). There were no differences concerning correction of the sagittal plane deformity between the two groups. Fusion length was, on average, 0.6 segments shorter in the screw group compared to the hook group ( P=0.03). With pedicle screws, the lowest instrumented vertebra was usually one below the lower end vertebra, whereas in the hook group it was between one and two vertebrae below the lower end vertebra. Both operative time and intraoperative blood loss were significantly higher in the hook group ( P<0.0001). One pedicle screw at T5 was exchanged due to the direct proximity to the aorta. There were no neurologic complications related to pedicle screw instrumentation. Pedicle screw instrumentation alone or in combination with proximal hook instrumentation offers a significantly better primary and secondary curve correction in idiopathic thoracic scoliosis and enables a significantly shorter fusion length.     

Comparison of novel ultra-high molecular weight polyethylene tape versus conventional metal wire for sublaminar segmental fixation in the treatment of adolescent idiopathic scoliosis

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare the surgical outcomes of posterior translational correction and fusion using hybrid instrumentation systems with either sublaminar Nesplon tape or sublaminar metal wire to treat adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: Nesplon tape, which consists of a thread of ultra-high molecular weight polyethylene fibers, has advantages over metal wire: (1) its soft and flexible properties avoid neural damage and (2) its flat configuration avoids focal distribution of the stresses to lamina; however, the efficacy of Nesplon tape in the correction of spinal deformity is as yet, still unclear. METHODS: Thirty AIS patients at a single institution underwent posterior correction and fusion using hybrid instrumentation containing hook, pedicle screw, and either sublaminar polyethylene taping (15) or sublaminar metal wiring (15). Patients were evaluated preoperatively, immediately after surgery, and at a 2-year follow-up according to the radiographic changes in curve correction, operating time, intraoperative blood loss, complications, and the Scoliosis Research Society patient questionnaire (SRS-24) score. RESULTS: The average correction rate was 63.0% in the Nesplon tape group and 59.9% in the metal wire group immediately after surgery (P = 0.62). Fusion was obtained in all the patients without significant correction loss in both groups. There was no significant difference in operative time, intraoperative blood loss, and postoperative SRS-24 scores between the 2 groups. Complications were superficial skin infection in a single patient in the Nesplon tape group, and transient sensory disturbance in 1 patient and temporal superior mesenteric artery syndrome in another patient in the metal wire group. CONCLUSIONS: The efficacy of Nesplon tape in correction of deformity is equivalent to that of metal wire, and fusion was completed without significant correction loss. The soft and flexible properties and flat configuration of Nesplon tape make this a safe application for the treatment of AIS with bone fragility or with the fusion areas containing the spinal cord.     

Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80° traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5–8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic (>80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80° (Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF–H group; n = 27 patients), or with pedicle screw-only construct (PSF–S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser’s sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF–H: 92° vs. PSF–S: 88°), or flexibility on bending films (PSF–H: 27% vs. PSF–S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for non-parametric paired analysis, and the Mann–Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF–S group, when compared to the PSF–H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of −1.9° versus −11.3° (P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (−1.00 vs. −0.54 cm; P = 0.04), and tilt (−19° vs. −10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF–H = 0.5 cm vs. PSF–S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and stable correction of severe scoliosis. However, severe curves may be amenable to hybrid instrumentation that produced analogous results to the screws-only constructs concerning patient satisfaction; at the latest follow-up, SRS-30 and SF-36 scores did not show any statistical differences between the two groups. Presented at 8th Annual Meeting of the Spine Society of Europe, October 2006, Istanbul, Turkey.     

Correction of adolescent idiopathic scoliosis using thoracic pedicle screw fixation versus hook constructs

This retrospective study was undertaken to determine the effectiveness and cost of thoracic pedicle screws versus laminar and pedicle hooks in patients undergoing surgical correction of adolescent idiopathic scoliosis (AIS). Immediate preoperative and 6-week postoperative radiographs were examined in 25 consecutive cases of children with AIS who were divided into two groups, those with thoracic pedicle screw constructs and those with thoracic hook constructs. Endpoints collected included radiographic measures, complications, surgical time, implant cost, and quality-of-life measures. Ten children underwent spinal fusion using thoracic pedicle screw fixation and 15 underwent thoracic constructs composed of hooks. Similar sex and age distribution were noted in both groups, and among the 20 girls and 5 boys the average age was 14.5. The mean preoperative Cobb angle was 53.5 degrees for the screw group and 52.5 degrees for the hook group. Correction averaged 70.2% for the screw group and 68.1% for the hook group. There were no significant differences between the two patient groups in terms of percentage of or absolute curve change after surgery. The apical vertebral translation, end vertebral tilt angle, and coronal balance did not differ significantly between the two patient groups. Comparison of operative time and quality of life revealed no significant differences. Screw constructs were significantly more expensive than hook constructs. The correction obtained from thoracic pedicle screw fixation is comparable to traditional hook constructs in AIS. Surgery using either construct effectively corrects AIS.     

All pedicle screw instrumentation for Scheuermann's kyphosis correction: is it worth it?

Background contextScheuermann's kyphosis has long been treated by a two-staged fusion and instrumentation with a hybrid construct using hooks, pedicle screws, and sublaminar wires. Recent interest in all pedicle screw constructs led to its use in the treatment of Scheuermann's kyphosis. Evaluation of this newly described application is needed.PurposeTo compare the results of segmental all pedicle screw constructs versus two-staged hybrid instrumentation in patients with Scheuermann's kyphosis analyzing the amount of correction and incidence of complications.Study designRetrospective case series reporting on two groups of patients with Scheuermann's kyphosis treated with single-staged all pedicle screws technique versus two-staged anterior release and posterior hybrid instrumentation followed-up for a minimum of 2 years.Patient sampleThe study included 33 patients divided into two groups. The average age was 15 years+9 months and 16 years+8 months, respectively. The average preoperative dorsal kyphosis was 85.5 degrees (Group 1) and 79.8 degrees (Group 2).Outcome measuresThe deformity was measured by Cobb's method preoperatively, postoperatively, and at final follow-up. Operative time and blood loss were also measured and recorded. The results of the Scoliosis Research Society (SRS)-30 questionnaire were also reviewed.MethodsThe study included 16 patients who underwent a single-staged correction by segmental all pedicle screw constructs and multiple-level posterior osteotomies (Group 1) and 17 who underwent a two-staged fusion and instrumentation with a hybrid construct (Group 2).ResultsBoth groups were followed for a minimum of 2 years. The deformity correction of Group 1 had an average of 52.2% postoperatively with 2.4% loss at final follow-up in comparison to Group 2 where the correction was 48.7% postoperatively with 3.1% loss at final follow-up. The operative time was considerably less in Group 1 with an average of 215 minutes than Group 2 with an average of 315 minutes. The average blood loss was 620 cc in Group 1 and 910 cc in Group 2. The SRS-30 questionnaire in Group 1 averaged 134 and in Group 2 averaged 120.ConclusionsThe use of multiple-level all pedicle screws technique allowed a rigid anchor for posterior correction of the deformity with less operative time, blood loss, and hospital stay without the need for anterior release. A better correction was achieved and preserved with the use of all pedicle screw constructs. This technique is a useful modality in the treatment of Scheuermann's kyphosis.     

经伤椎单、双侧置钉内固定治疗胸腰椎骨折的疗效

目的探讨经伤椎单、双侧置钉内固定治疗胸腰椎骨折的疗效。方法采用后路短节段内固定治疗76例胸腰椎单一椎体骨折患者,按内固定方式的不同分成3组:跨伤椎4钉固定(A组)30例,伤椎单侧5钉固定(B组)16例,伤椎双侧6钉固定(C组)30例。比较3组患者术中出血量、手术时间、术后伤椎高度矫正率、末次随访伤椎高度和后凸角的矫正丢失率、内固定失效等。结果 3组患者术中出血量、手术时间及术后伤椎高度矫正率比较差异均无统计学意义(P0.05)。患者均获得随访,时间13~28个月。末次随访伤椎高度和后凸角的矫正丢失率:A组差于B、C组,差异具有统计学意义(P0.05,P0.01),B、C两组比较差异无统计学意义(P0.05)。B、C两组未出现断钉断棒等现象,A组有3例断钉。结论与传统的后路跨伤椎短节段内固定相比,经伤椎单、双侧置钉治疗胸腰椎骨折均能获得良好的复位和固定效果,内固定失效率低。