伴有C型腰弯的特发性青少年脊柱侧凸的选择性胸椎融合：钩与椎弓根螺钉比较课件

1、Selective Thoracic Fusion For AIS With Lumbar “C” Modifier Curves: Comparison of Hooks Versus Pedicle ScrewsIntroductionClassification schemes for Adolescent Idiopathic Scoliosis have attempted to identify patients with major thoracic and compensatory lumbar curves that are amenable to selective tho

2、racic fusion in order to preserve lumbar motion segments. Improper patient selection may lead to postoperative coronal decompensation (C7 plumb line deviation from CSVL). IntroductionAdolescent Idiopathic Scoliosis: A new classification to determine extent of spinal arthrodesis. Lenke L, Betz R, Har

3、ms J, Bridwell K, Clements D, Lowe T, Blanke K.; JBJS 2001:83A, 1169-1181Lenke “C” curves (lumbar apical vertebra translated lateral to CSVL) are considered greatest risk of postoperative coronal decompensationIntroductionRecent study has reported success with selective thoracic fusion in 44 patient

4、s with Lenke “C” curvesCorrection of apical translation was inconsistent: some remained “C” type curves while others corrected to “A” or “B” Preoperative global imbalance was a predictor of postoperative imbalanceSelective thoracic fusion for AIS with “C” lumbar modifier curves: 2-16 year radiograph

5、ic and clinical results. Dobbs, MB, Edwards CC, Lenke LG, Peelle MW, Sides B, Rinella A, Bridwell KH. Spine 2004; 29(5):536-546.COMPARATIVE ANALYSIS OF PEDICLE SCREW VS HOOK INSTRUMENTATION IN POSTERIOR SPINAL FUSION OF ADOLESCENT IDIOPATHIC SCOLIOSIS:A Matched Cohort AnalysisYongjung J. Kim, MD Law

6、rence G. Lenke, MDSamuel K. Cho, MD Keith H. Bridwell, MDSpinal Deformity ServiceWashington University School of MedicineSt. Louis Shriners HospitalSt. Louis, MissouriSRS 2003/AAOS 2004/POSNA 2004/Spine, SRS issue 29S(18):2040-2058, 2004 METHODSWell Matched Cohorts Op.Methods# ofFused VBLenke CurveT

7、ypeAge at SurgeryTPSN=26PSF+TPL 18PSF+ICBG 4PSF+Ant BG 411.7 Type 1: 14 Type 2: 7Type 3: 1Type 4: 2Type 6: 214.8YHookN=26PSF+TPL 18PSF+ICBG 4PSF+Ant BG 411.7 Type 1: 14Type 2: 7Type 3: 1Type 4: 2Type 6: 214.2Y Apples to Apples Comparison RESULTSComparison of Coronal Plane Change 1 Major Cobb Angle C

8、hange (Overall p value0.0001)(degree)IntroductionAnother study suggested the correction of the thoracic curve should mimic the push-prone radiograph Perhaps aggressive curve correction with pedicle screws may be contra-indicatedDobbs MB, Lenke LG, Corley CL, Bridwell KH, Peelle MW, Steger-May K. Can

9、 We Predict the Ultimate Lumbar Curve in Adolescent Idiopathic Patients Undergoing a Selective Fusion With Undercorrection of the Thoracic Curve? Spine 2004; 29(3):227-85.4121Push/Prone1 year post opC7 4330PurposeTo compare the results of selective posterior thoracic fusion using an all hook constru

10、ct versus an all pedicle screw construct in AIS major thoracic (Lenke 1C & 2C) curve types.Determine if the use of pedicle screws resulted in overcorrection of the thoracic curve and hence increased risk of lumbar Cobb decompensation.Methods66 consecutive AIS patients treated by two surgeons at a si

11、ngle institution from 1987-2001. All underwent selective thoracic fusions for Lenke 1C and Lenke 2C (major thoracic) curvesLowest instrumented vertebra T12 (30), L1 (36)Local bone and iliac crest graftComprehensive radiographic evaluationResultsHookPedicleScrewSignificanceAge (yrs)13.913.8NS% female

12、7879NSRisser2.11.9NSFollow-up(yrs)10 (2-12)6 (2-8)NS (p=.36)Results Preoperative CobbCobb angle (degrees)Thoracic MeasurementsLumbar Measurementsp=.74 p=.54 p=.63 p=.59 p=.47 p=.83 No difference in hook vs. pedicle screw groups in preoperative static or bending Cobb measurementsResults Thoracic Corr

13、ectionPedicle screw correction greater than hook correction ( 44% vs. 33% ) (p0.004)p=0.74 p0.004Results Lumbar CorrectionPedicle screw correction greater than hook correction ( 38% vs. 32% ) (p0.005)p=0.59 p 2cm) was higher in the hook group (13 patients) as compared to the pedicle screw group (4 patients) The lowest instrumented vertebrae was on average 1 level shorter for the pedicle screw group (p0.001).ConclusionsOur study demonstrated that pedicle screw fixation has the following advantages over hook constructs in AI