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  • 邹一鸣,陈锴,赵检,白锦毅,杨长伟,李明,康一凡.不同置钉密度选择性置钉法对LenkeⅠ型青少年特发性脊柱侧凸后路矫形效果的影响[J].第二军医大学学报,2019,40(6):614-618    [点击复制]
  • ZOU Yi-ming,CHEN Kai,ZHAO Jian,BAI Jin-yi,YANG Chang-wei,LI Ming,KANG Yi-fan.Curative effect of selective screw placement with different screw densities in treatment of LenkeⅠadolescent idiopathic scoliosis: a comparative study[J].Acad J Sec Mil Med Univ,2019,40(6):614-618   [点击复制]
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不同置钉密度选择性置钉法对LenkeⅠ型青少年特发性脊柱侧凸后路矫形效果的影响
邹一鸣1△,陈锴2△,赵检2,白锦毅2,杨长伟2,李明2,康一凡1*
0
(1. 海军军医大学(第二军医大学)东方肝胆外科医院骨科, 上海 200438;
2. 海军军医大学(第二军医大学)长海医院骨科脊柱外科, 上海 200433
共同第一作者
*通信作者)
摘要:
目的 评估Lenke Ⅰ型青少年特发性脊柱侧凸(AIS)患者应用选择性置钉法进行后路三维矫形术的疗效,并比较不同置钉密度对术后矫形参数的影响。方法 回顾性纳入2013年1月至2017年1月在海军军医大学(第二军医大学)长海医院骨科脊柱外科行脊柱侧凸后路矫形+选择性融合内固定术的Lenke Ⅰ型AIS患者。参考文献定义置钉密度为置钉数量/(融合节段×2),按置钉密度将患者分为高密度组(置钉密度>0.7)和低密度组(置钉密度≤ 0.7),比较两组患者的一般资料和术后2周手术矫正率、术后2年手术矫正率、2年矫正率丢失及矫正比率。结果 纳入Lenke Ⅰ型AIS患者36例,男11例、女25例,平均年龄为(13.97±1.89)岁。高密度组23例、低密度组13例,置钉密度分别为0.80±0.04、0.64±0.06,差异有统计学意义(t=10.799,P<0.01)。两组患者性别构成比、年龄、使用椎弓根螺钉的品牌、术前冠状位主弯Cobb角、术前侧屈位Cobb角、术前侧凸柔韧度差异均无统计学意义(P均> 0.05)。与高密度组比较,低密度组患者术后2周冠状位主弯Cobb角、手术矫正率及术后2年冠状位主弯Cobb角、矫正率丢失均无明显劣势(P均>0.05)。相关性分析结果显示,术后2周手术矫正率、矫正比率及术后2年矫正率丢失与置钉密度均无明显相关性(r=0.149、0.348、0.217,P=0.387、0.874、0.177)。结论 对于柔韧性较好的Lenke Ⅰ型AIS患者,使用选择性置钉进行矫形时适当减少置钉数目可能不会对术后近期和中期疗效造成不利影响。
关键词:  青少年特发性脊柱侧凸  选择性置钉  置钉密度  矫形参数
DOI:10.16781/j.0258-879x.2019.06.0614
投稿时间:2019-05-10修订日期:2019-05-30
基金项目:国家自然科学基金(31870985),上海市自然科学基金(16ZR1449100).
Curative effect of selective screw placement with different screw densities in treatment of LenkeⅠadolescent idiopathic scoliosis: a comparative study
ZOU Yi-ming1△,CHEN Kai2△,ZHAO Jian2,BAI Jin-yi2,YANG Chang-wei2,LI Ming2,KANG Yi-fan1*
(1. Department of Orthopedics, Eastern Hepatobiliary Surgery Hospital, Naval Medical University(Second Military Medical University), Shanghai 200438, China;
2. Department of Spine Surgery, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
Co-first authors.
* Corresponding author)
Abstract:
Objective To evaluate the curative effect of selective screw placement of posterior three-dimensional correction for LenkeⅠadolescent idiopathic scoliosis (AIS), and to compare the effects of different screw densities on the orthopedic parameters. Methods We retrospectively analyzed the clinical data of LenkeⅠAIS patients undergoing posterior correction of scoliosis+selective fusion and internal fixation surgery in Department of Spine Surgery of Changhai Hospital of Naval Medical University (Second Military Medical University) between Jan. 2013 and Jan. 2017. According to the references, the screw density was defined as the number of nails/(fusion segment×2). The patients were divided into high density group (screw density>0.7) and low density group (screw density ≤ 0.7). The general characteristics, surgical correction rates 2 weeks and 2 years after operation, loss of correction rate after 2 years and correction ratio were compared between the two groups. Results A total of 36 eligible patients (11 males and 25 females) with LenkeⅠAIS were included in this study, with an average age of (13.97±1.89) years old. There were 23 cases in the high density group and 13 cases in the low density group, with the screw densities being 0.80±0.04 and 0.64±0.06, respectively, and the difference was significant (t=10.799,P<0.01). There were no significant differences in gender, age, brand of pedicle screw, preoperation coronal main curve Cobb angle, preoperation bending Cobb angle or preoperation scoliosis flexibility between the two groups (all P>0.05). Compared with the high density group, the low density group had no significant disadvantages in coronal main curve Cobb angles 2 weeks and 2 years after operation, surgical correction rate 2 weeks after operation, or loss of correction rate 2 years after operation (all P>0.05). Pearson correlation analysis showed that there were no significant correlations between screw density and surgical correction rate 2 weeks after operation, correction ratio and the loss of correction rate (r=0.149, 0.348, 0.217; P=0.387, 0.874, 0.177). Conclusion For LenkeⅠAIS patients with better flexibility, appropriate reduction of the nail number in selective screw placement surgery may not adversely affect the short-term and mid-term outcomes.
Key words:  adolescent idiopathic scoliosis  selective screw placement  screw density  orthopedic parameters