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目的分析比较采用不同内固定物组合形式对青少年特发性脊柱侧凸患者行后路选择性胸椎融合的矫形效果。方法根据内固定物组合形式的不同将患者分为三组:组A:内固定钩组;组B:混合组(内固定钩+椎弓根螺钉);组C:全节段椎弓根螺钉组分析比较三组患者的矫形效果。结果:共57例患者,组A 9例,组B 30例,组C 18例。平均年龄14.3岁,平均随访时间19.6个月。三组患者主胸弯冠状面Cobb角术前分别为49.0°、48.8°和47.4°,术后分别矫正到15.1°、13.7°和6.8°,随访时分别为19.0°、17.0°和9.5°,胸弯矫形率分别为62.1%、64.6%和79.0%,矫形率组C优于组A与组B(P=0.014,P=0.003),组B与组A比较差异无统计学意义(P=0.688);术前腰弯冠状面Cobb角分别为32.4°、32.6°和35.2°,术后分别矫正到12.0°、8.6°和8.3°,随访时分别为16.3°、10.3°和11.1°,随访时腰弯自动矫形率分别为48.9%,66.8%和69.9%,矫形率组B与组C优于组A(P=0.012,P=0.008),组C优于组B(P=0.003)。结论不论使用何种内固定物组合形式,主胸弯和腰弯均可获得良好的矫形效果,但全节段椎弓根螺钉固定组胸弯和腰弯矫形效果更佳。
Objective To analyze and compare the orthopedic effects of posterior selective thoracic fusion in adolescent patients with idiopathic scoliosis by using different combinations of internal fixators. Methods The patients were divided into three groups according to the combination of internal fixation: group A: internal fixation hook group; group B: mixed group (internal fixation hook + pedicle screw); group C: full segmental pedicle screw Group analysis of the orthopedic effect of three groups of patients. Results: A total of 57 patients, group A 9 cases, group B 30 cases, group C 18 cases. The average age was 14.3 years and the average follow-up time was 19.6 months. The coronal Cobb angle of the primary chest and thoracic curves were 49.0 °, 48.8 ° and 47.4 ° in the three groups respectively, and were corrected to 15.1 °, 13.7 ° and 6.8 ° after operation respectively. The follow-up time was 19.0 °, 17.0 ° and 9.5 °, respectively. The correction rate of thoracic spondylolisthesis was 62.1%, 64.6% and 79.0% respectively. The orthopedic rate group C was superior to group A and group B (P = 0.014, P = 0.003). There was no significant difference between group B and group A (P = 0.688). Coronal Cobb angles were 32.4 °, 32.6 ° and 35.2 °, respectively. Corrections were performed at 12.0 °, 8.6 ° and 8.3 ° respectively. The follow-up was 16.3 °, 10.3 ° and 11.1 °, respectively. Follow-up The automatic correction rate was 48.9%, 66.8% and 69.9% respectively in group B and C, and group C was superior to group A (P = 0.012, P = 0.008). Group C was superior to group B (P = 0.003). Conclusion No matter what type of internal fixator combination is used, the main thoracic curve and lumbar curve can obtain good orthopedic effect, but the full segmental pedicle screw fixation group is more effective in the treatment of thoracic curve and lumbar curve.