Posterior screw-rod fixation for idiopathic scoliosis: factors affecting the results

doi:10.3969/j.issn.2095-4344.2014.09.011

Abstract

Abstract:

BACKGROUND: Idiopathic scoliosis is most common among all the scoliosis. Accompanied by the nervous system, the endocrine system as well as nutritional and metabolic abnormalities, patients usually cannot be redressed and cured by conservative treatment, but often require surgical operation. Surgery for malformation is a very complicated project, and is really of great significance for an in-depth research on treatment and turnover of idiopathic scoliosis.
OBJECTIVE: To observe the correction effect of posterior screw-rod fixation for idiopathic scoliosis, and explore the relevant factors influencing its effectiveness.
METHODS: We retrospectively analyzed 80 cases receiving pedicle screw fixation in the treatment of idiopathic scoliosis in the latest four years. Age, gender, disease duration, preoperative and postoperative X-ray measurement of coronal Cobb’s angle, and trunk deviation were recorded, and statistically analyzed.
RESULTS AND CONCLUSION: Univariate analysis showed that gender and disease duration were not significantly correlated with postoperative correction results (P > 0.05). However, the age distribution of patients, the location of scoliosis, and scoliosis flexibility were associated with curative effects of internal fixation (P < 0.05). Posterior screw-rod fixation for idiopathic scoliosis can achieve significant effects. The patient’s age, location and flexibility of scoliosis have a significant effect on the effects of fixation. The patient’s gender and disease duration had no significant effect on fixation effects.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: spine, spinal curvatures, scoliosis, internal fixators, bone nails, orthotic devices

CLC Number:

R318

Bi Zhong-pu, Xia Lei, Xu Jing-lei, Zhou Ya-qi, Ke Guang-shui, Sang Liang . Posterior screw-rod fixation for idiopathic scoliosis: factors affecting the results[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(9): 1374-1379.

Figures/Tables 3

2.1 纳入患者数量分析回顾性分析采用的是分析内固定前和内固定后1周，即拆线前未出院的影像学数据，所以非常规调查随访，不存在脱落人数及原因，依纳入标准和排除标准选定80例患者，全部按照意向性分析。 2.2 患者相关因素与内固定后矫正率的关系年龄与内固定后矫正率的关系：年龄≥18岁的26 例患者中，躯干偏移度矫正率78.0%，Cobb’s角矫正率86.6%。年龄<18岁的54 例患者中，躯干偏移度矫正率66.0%；Cobb’s角矫正率82.9%；躯干偏移度对应P=0.037，Cobb’s角矫正率对应P’=0.029。年龄比例比较差异有显著性意义(P < 0.05)，提示年龄因素与内固定后矫正率相关(表1)。性别与内固定后矫正率的关系：男性患者22例，躯干偏移度矫正率76.0%，Cobb’s角矫正率83.3%；女性患者58例，躯干偏移度矫正率71.0%，Cobb’s角矫正率85.8%；躯干偏移度对应P=0.081，Cobb’s角矫正率对应P’=0.074。性别比例比较差异无显著性意义(P > 0.05)，提示性别因素与内固定后矫正率无显著相关性(表1)。病程与内固定后矫正率的关系：病程≥2年的患者33例，躯干偏移度矫正率76.0%，Cobb’s角矫正率87.7%；病程<2年的患者47例，躯干偏移度矫正率70.0%，Cobb’s角矫正率78.8%，躯干偏移度对应P=0.069，Cobb’s角矫正率对应P’=0.057。病程比例比较差异无显著性意义(P > 0.05)，提示病程因素与内固定后矫正率之间无显著相关性(表1)。侧凸的位置与内固定后矫正率的关系：单纯胸弯(Lenke 1型)患者42例，躯干偏移度矫正率61.0%，Cobb’s角矫正率为81.7%；合并腰弯的患者38例，躯干偏移度矫正率80.0%，Cobb’s角矫正率为86.7%；躯干偏移度对应P=0.037，Cobb’s角矫正率对应P’=0.040。侧凸的位置比例比较，差异有显著性意义(P < 0.05，P ’ < 0.05)，提示侧凸的位置与内固定后矫正率相关(表1)。侧凸的柔韧性与内固定后矫正率的关系：侧凸柔韧性≥50%的患者27例，躯干偏移度矫正率80.0%，Cobb’s矫角正率86.7%；侧凸柔韧性< 50%的患者53例，躯干偏移度矫正率67.0%，Cobb’s矫角正率79.4%；躯干偏移度对应P=0.048，Cobb’s角矫正率对应P’=0.022。侧凸的位置比例比较，差异有显著性意义(P < 0.05)，提示侧凸柔韧性与内固定后矫正率相关(表1)。 "

References

[1]覃佳强,张德文.儿童脊柱畸形的支具治疗[J].中国矫形外科杂志,2004,12(1):25-27.

[2]Bradford DS,Tay BK,Hu SS. Adult scoliosis:surgical indications,operative management,complications,and outcomes. Spine. 1999;24(24):2617-2629.

[3]Harrington PR. Treatment of scoliosis. Correction and internal fixation by spine instrumentation.J Bone Joint Surg Am.1962 (44-A):591-610.

[4]Smith JA. Adult deformity:management of sagittal plane deformity in revision adult spine surgery. Orthopaedics. 2001; 12(3):206-215.

[5]Luque ER. The anatomic basis and development of segmental spinal instrumentation.Spine. 1982;7(3):256-259.

[6]Buttermann GR, Thorson TM, Mullin WJ. Outcomes of posterior facet versus pedicle screw fixation of circumferential fusion: a cohort study. Eur Spine J. 2013 Oct 2.

[7]Cotrel Y,Duhousset J. A new technic for segmental spinal osteosynthesis using the posterior approach.Rev Chir Orthop Reparatrice Appar Mot. 1984;70(6):489-494.

[8]Kim YJ,Lenke LG,Cho SK.et al. Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine. 2004;29(18): 2040-2048.

[9]邱贵兴,庄乾.青少年特发性脊柱侧凸的流行病学研究进展[J].中华医学杂志,2006,86(11):790.

[10]Robert F.Heary ,Todd J.Albert.Spinal Deformities[M].New York,USA:Thieme Medical Publishers,2007:2-3.

[11]周春光,刘立岷,宋跃明,等.重度僵硬性特发性脊柱侧凸患者术后肺功能变化[J].中国修复重建外科杂志,2010,24(1):23-26.

[12]Ni H, Zhu X, He S, et al. An increased kyphosis of the thoracolumbar junction is correlated to more axial vertebral rotation in thoracolumbar/lumbar adolescent idiopathic scoliosis. Spine (Phila Pa 1976). 2010;35(23):E1334-1338.

[13]王智伟,邱勇,王渭君,等.青少年特发性主胸弯脊柱侧弯患者骨盆旋转的影响因素[J].中华小儿外科杂志,2012,33(2): 126-130.

[14]Lenke LG, Sides BA, Koester LA, et al.Vertebral column resection for the treatment of severe spinal deformity. Clin Orthop RelatRes. 2010;468(3):687-699.

[15]刘巍,陈庆贺.青少年特发性脊柱侧凸的手术治疗[J].中国矫形外科杂志,2010,16(5):405-408.

[16]Sarlak AY, Bulu L, Sarisoy HT, et al. Placement of pedicle screws in thoracic idiopathic scoliosis: a magnetic resonance imaging analysis of screw placement relative to structures at risk.Eur Spine J.2008;17(5):657.

[17]Wang X, Pang X, Wu P, et al. One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J. 2013 Oct 1.

[18]Popp AW, Schwyn R, Schiuma D, et al. DensiProbe Spine: an intraoperative measurement of bone quality in spinal instrumentation. A clinical feasibility study. Spine J. 2013; 13(10):1223-1229.

[19]Pizanis A, Holstein JH, Vossen F, et al. Compression and contact area of anterior strut grafts in spinal instrumentation: a biomechanical study. BMC Musculoskelet Disord. 2013;14: 254.

[20]Cho W, Mason JR, Smith JS, et al. Failure of lumbopelvic fixation after long construct fusions in patients with adult spinal deformity: clinical and radiographic risk factors: clinical article. J Neurosurg Spine. 2013;19(4):445-453.

[21]Choi KC, Ryu KS, Lee SH, et al. Biomechanical comparison of anterior lumbar interbody fusion: stand-alone interbody cage versus interbody cage with pedicle screw fixation -- a finite element analysis. BMC Musculoskelet Disord. 2013;14: 220.

[22]Shapiro GS,Taira G,Boachie-Adjei O. Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis:a study of long-term clinical radiographic outcomes. Spine 2003;28(4):358-363.

[23]Wu P, Luo C, Pang X, et al. Surgical treatment of thoracic spinal tuberculosis with adjacent segments lesion via one-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion, a clinical study. Arch Orthop Trauma Surg. 2013;133(10): 1341-1350.

[24]Suk SI, Kim JH, Kim SS, et al. Thoracoplasty in thoracic adolescent idiopathic scoliosis.Spine (Phila Pa 1976).2008; 33(10):1061-1067.