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首页> 外文期刊>Spine >Rotational changes of the vertebral pelvic axis after sublaminar instrumentation in adolescent idiopathic scoliosis.
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Rotational changes of the vertebral pelvic axis after sublaminar instrumentation in adolescent idiopathic scoliosis.

机译：青少年特发性脊柱侧弯椎板下器械置入后椎体骨盆轴的旋转变化。

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STUDY DESIGN: The authors studied the rotational effect of sublaminar wiring on the spinal pelvic axis on 20 patients who were being treated for adolescent idiopathic scoliosis. OBJECTIVES: To determine if sublaminar wiring effectively derotates the scoliotic spine. SUMMARY OF BACKGROUND DATA: The correction of the rotational deformity in adolescent scoliosis via sublaminar wiring is not well quantified in the literature. The derotation maneuver of Cotrel-Dubousset has been shown to produce variable and unpredictable amounts of axial derotation. METHODS: Twenty patients who underwent posterior spine fusion for adolescent idiopathic scoliosis were evaluated using computed tomography scans and plain radiography before and after surgery and at a subsequent follow-up examination (average time of follow-up examination, 35 months after surgery). The degree of angle of vertebral rotation about the sagittal plane and that relative to the pelvis were measured before and after surgery and at a follow-up examination. RESULTS: The primary thoracic curves were not derotated significantly relative to the pelvis with sublaminar wiring. Primary thoracolumbar curves instrumented on the convexity with pedicle screws were derotated significantly relative to the pelvis (P = .001). The average initial correction was 57%. On final follow-up examination, the correction was 24% (18 of 20 twenty individuals lost axial correction by an average of 34%). In nine of 20 patients the spine was more rotated, relative to the pelvis, than it had been before surgery. No coronal or sagittal decompensation was seen in any curve type. CONCLUSIONS: Coronal and sagittal plane correction of scoliotic curves may be achieved with sublaminar instrumentation. The ability to derotate axially the scoliotic spine appears to be variable, however, and, in most cases, curve-type dependent. Over time, much correction appears to be lost, and in many patients the scoliosis actually becomes worse than it was before surgery. Nonetheless, the apical derotation that takes place appears to be reasonably true: the percent correction of angle of rotation about the sagittal plane and the percent correction of angle of rotation about the sagittal plain relative to the pelvis were closely correlated. Derotation forces applied to the instrumented spine do not appear to be transmitted to more distal segments.
机译：研究设计：作者研究了20例青少年特发性脊柱侧弯患者的椎板下层布线对骨盆轴的旋转作用。目的：确定椎板下连线是否能有效地使脊柱侧凸旋转。背景资料的总结：在文献中没有很好地量化通过椎板下布线对青少年脊柱侧弯旋转畸形的校正。已经证明，Cotrel-Dubousset的扭转操作会产生可变且不可预测的轴向扭转量。方法：对20例因青少年特发性脊柱侧凸进行后路脊柱融合术的患者，在手术前后以及随后的随访检查（平均随访时间，术后35个月）中使用计算机断层扫描和X线平片进行评估。在手术前后和随访检查中测量椎骨围绕矢状面旋转的角度以及相对于骨盆的旋转角度。结果：相对于骨盆下层的骨盆，主胸曲线没有明显的扭转。椎弓根螺钉在胸凸上的主要胸腰弯曲线相对于骨盆有明显的旋转（P = .001）。平均初始校正为57％。在最终的随访检查中，矫正率为24％（20例个人中有18例轴向矫正平均损失了34％）。在20例患者中，有9例相对于骨盆，脊柱旋转得比手术前要多。在任何曲线类型中均未见冠状或矢状代偿失调。结论：椎板下仪器可实现脊柱侧弯曲线的冠状和矢状面矫正。脊柱侧弯轴向旋转的能力似乎是可变的，但是，在大多数情况下，取决于曲线类型。随着时间的流逝，似乎失去了很多矫正，并且在许多患者中，脊柱侧弯实际上变得比手术前更严重。但是，发生的根尖旋转似乎是正确的：相对于骨盆，围绕矢状面的旋转角度的校正百分比与围绕矢状面的旋转角度的校正百分比紧密相关。施加在器械脊柱上的扭转力似乎没有传递到更多的远端节段。

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