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首页> 外文期刊>Scoliosis >Significant variability in surgeons’ preferred correction maneuvers and instrumentation strategies when planning adolescent idiopathic scoliosis surgery
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Significant variability in surgeons’ preferred correction maneuvers and instrumentation strategies when planning adolescent idiopathic scoliosis surgery

机译：在计划青少年特发性脊柱侧弯手术时，外科医生首选的矫正策略和器械策略存在很大差异

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Increased implant number is thought to provide better control on the scoliotic spine, but there is limited scientific evidence of improved deformity correction and surgical outcomes with high-density constructs. The objective is to assess key anchor points used by experienced spinal deformity surgeons and to evaluate the effect of implant density pattern on correction techniques. Seventeen experienced spine surgeons reviewed five Lenke 1 adolescent idiopathic scoliosis cases and provided their preferred posterior correction technique (implant pattern, correction maneuvers, and implants used for their execution) and an alternative technique with the minimal implant density they felt would be acceptable (170 surgical plans total). Additionally, for each case, they selected acceptable screw patterns for surgery from seven published implant configurations. Variability in the surgeons’ plans was assessed, including instrumentation and correction strategies. The preferred correction plan involved an average of 1.65 implants/vertebra, with 88% of the available anchor points at the apex ±?1 vertebra used for the execution of correction maneuvers and only 43% of possible anchor points used proximal and distal to the apical area. The minimal density that surgeons found acceptable was 1.24 implants/vertebra. The minimal density plan involved more in situ rod contouring (53 vs. 41%), fewer vertebral derotation maneuvers (82 vs. 96%), and fewer implants used for compression/distraction maneuvers (1.18 and 1.42 respectively) (p 70% agreement). Implant position and number affect?surgeons correction maneuvers selection. For low implant density constructs, dropout in the convexity and particularly in the periapical region is accepted by surgeons, with minor influence on planned correction maneuvers. Thus, preoperative implant planning must take into account which anchor points are needed for desired correction maneuvers.
机译：植入物数量的增加被认为可以更好地控制脊柱侧弯，但是在高密度结构下改善畸形矫正和手术效果的科学证据有限。目的是评估有经验的脊椎畸形外科医生使用的关键锚点，并评估植入物密度模式对矫正技术的影响。十七名经验丰富的脊柱外科医师回顾了五例Lenke 1青少年特发性脊柱侧凸病例，并提供了他们首选的后路矫正技术（植入物样式，矫正方法和用于执行的植入物），以及一种他们认为可接受的最小植入物密度的替代技术（170例外科手术）计划总数）。此外，针对每种情况，他们从七个公开的植入物配置中选择了可接受的手术螺钉样式。评估了外科医生计划的可变性，包括仪器和校正策略。首选的矫正计划平均为1.65个植入物/椎骨，其中88％的可用锚点位于顶点±？1椎骨上，用于执行矫正操作，而只有43％的可能的锚点用于根尖的近端和远端区。外科医生发现可接受的最小密度为1.24植入物/椎骨。最小密度计划涉及更多的原位杆轮廓（53 vs. 41％），较少的椎骨扭转操作（82 vs. 96％），以及用于压缩/牵引操作的植入物较少（分别为1.18和1.42）（p 70％一致）。植入物的位置和数量会影响外科医生的矫正策略。对于低植入物密度的结构，外科医生会接受凸面特别是根尖周围区域的脱落，对计划的矫正操作影响很小。因此，术前植入物规划必须考虑到期望的矫正操作需要哪些锚固点。

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