摘要
目的 评估应用长尾矢状单平面螺钉结合双棒相向去旋转矫治技术治疗青少年特发性脊柱侧凸(AIS)的疗效.方法 回顾性分析 2018 年 9 月至 2022 年 9 月 90 例均接受后路矫形内固定融合术治疗AIS患者的影像学资料,根据植入物类型分为长尾矢状单平面螺钉(以下简称"长尾钉")组(48 例)和万向螺钉组(42例).两组均使用双棒相向去旋转技术.统计两组患者年龄、性别、手术时间、术中出血量、Risser征,并测量术前、术后即刻及末次随访时的主弯Cobb角、顶椎旋转度(AVR)、最下固定椎(LIV)下位椎间盘成角、最下固定椎一骶骨中垂线(LIV-CSVL)间距、锁骨角(CA)、影像学肩高度(RSH)等,计算冠状面畸形矫正率、顶椎去旋转矫正率和远端附加现象的发生率.术前、术后即刻及末次随访使用SRS-22 量表评估患者生活质量.结果 长尾钉组术后平均随访时间为 30.2(24～38)个月;万向螺钉组术后平均随访时间为 31.8(24～41)个月.两组患者在术后即刻的主弯Cobb角、主弯Cobb角矫正率、AVR、胸椎后凸角(TK)及剃刀背(RH)差异均有统计学意义(P均＜0.05);RSH、CA及腰椎前凸角(LL)差异均无统计学意义(P均＞0.05).两组患者在末次随访时的主弯Cobb角、主弯Cobb角矫正率、AVR分级、下位椎间盘成角(LIV)、TK及RH差异均有统计学意义(P均＜0.05).两组患者的年龄、性别、随访时间、术中出血量、Risser征差异均无统计学意义(P均＞0.05),在手术时间上差异有统计学意义(P＜0.05).两组患者术前主弯Cobb角、TK、LL、RSH、CA以及RH差异均无统计学意义(P均＞0.05).术前和末次随访时,两组患者SRS-22 量表的疼痛、功能/活动度、心理状况、治疗满意度和自我形象 5 个维度的差异均无统计学意义(P均＞0.05).结论 长尾矢状单平面椎弓根螺钉双棒相向去旋转技术治疗AIS相较传统组具有更好的去旋转效果、更低的远端附加现象发生率,并且可获得满意的外观效果.
Abstract
Objective To assess the efficacy of the long-tailed sagittal uniplanar screws double-rod derotation correction technique with the treatment of adolescent idiopathic scoliosis(AIS).Methods The imaging data of 90 patients with AIS from September 2018 to September 2022 were retrospectively analyzed.All patients were treated with posterior orthopedic internal fusion.Of these patients 48 cases were included in the long-tailed sagittal uniplanar screw group(LSUSG)and the other 42 cases were enrolled in the multiaxial screw group(MSG)according to the types of implants.Age,gender,operation time,blood loss,Risser sign of the two groups were counted.Patients were evaluated preoperative,postoperative,and final follow-up in radiographic changes in coronal and sagittal planes.The correction rate of coronal deformity,the correction rate of vertex rotation and the incidence of distal additional phenomena were calculated in both groups.The quality of life of patients was evaluated by the SRS-22 scale before the operation,immediately after the operation and at the last follow-up.Results The average postoperative follow-up time in the long-tail sagittal uniplanar screw group was 30.2(24-38)months.The average postoperative follow-up time in the multiaxial screw group was 31.8(24-41)months.There were statistical differences in Cobb angle of main curve,correction rate of Cobb angle of main curve,AVR,CSVL,LIV,TK,and RH between the two groups immediately after operation(P all＜0.05).RSH,CA and LL was not statistically significant(P all＞0.05).After the operation,there were statistical differences in Cobb angle of main curve,correction rate of Cobb angle of main curve,classification of vertex rotation,LIV,TK and RH between the two groups(P all＜0.05).There was no statistical differences in age,gender,fol-low-up time,intraoperative blood loss and Risser sign between the two groups(P all＞0.05),but there was a statistical difference in operation time between the two groups(P＜0.05).Cobb angle,TK,LL,RSH,CA and RH before operation were not statistically significant(P all＜0.05).Before operation and final follow-up after the operation,there was no significant differences in five dimensions of SRS-22:pain,function/range of motion,mental health,treatment satisfaction and self-image(P all＞0.05).Conclusion The long-tailed sagittal unipla-nar screw double-rod derotation technique compared with MSG has better derotation effect and lower adding on rate.And it has better satisfactory cosmetic result.
基金项目
宁夏回族自治区重点研发计划(2023BEG02017)
宁夏医科大学总医院医工专项(NYZYYG-005)
维普
万方数据