Double claw construct with hooks for proximal fixation in adolescent idiopathic scoliosis: a randomized controlled trial.

IF 1.8 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2025-08-28 DOI:10.1007/s43390-025-01161-5

J J M Renkens, A Willems, M Reijman, P de Baat, L W L de Klerk, J P H J Rutges

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引用次数: 0

Abstract

Purpose: Proximal fixation in adolescent idiopathic scoliosis (AIS) surgery is a matter of discussion. All screw (AS) constructs provide better coronal correction than hybrid constructs, but high thoracic pedicle screw placement can be challenging. This study investigated whether an AS-construct provides better correction than a proximal double hook-claw (PH) construct.

Methods: AIS patients undergoing posterior spinal fusion (PSF) were randomized to AS-construct or PH-construct from 2016 to 2020 with a two-year follow-up. Primary outcome is the main thoracic (MT) Cobb angle correction after two years. Secondary outcomes are thoracic kyphosis (TK), proximal junctional angle (PJA), proximal thoracic (PT) Cobb angle, SRS-22r, and complications after two years.

Results: 60 patients (30 AS, 30 PH) were included. No baseline differences were found. Preoperative MT Cobb angle was 62° ± 11° (AS) vs. 65° ± 12° (PH). There was no statistical difference in MT Cobb angle after two years: 25° ± 9° (AS) vs. 27° ± 7° (PH) (p = 0.247). No difference in PT Cobb angle was found: 20° ± 9° (AS) vs. 21° ± 9° (PH) and TK: 23° ± 9° (AS) vs. 22° ± 7° (PH). SRS-22r improved in both groups with no statistical difference: 3.9 ± 0.5 to 4.3 ± 0.5 (AS) vs. 3.7 ± 0.5 to 4.3 ± 0.5 (PH). There were 13 complications (ten patients) in AS group and 17 (13 patients) in PH group, including 1 major complication in each group (deep wound infection).

Conclusion: AS-construct does not provide better coronal Cobb correction after two years after surgery. A PH-construct is a reliable and safe option for proximal fixation AIS patients. TRN: NTR-NL5552 (2016).

Trial registration: Overview of medical research in the Netherlands (OMON): NL-OMON43852.

查看原文本刊更多论文

双爪结构与钩近端固定青少年特发性脊柱侧凸：一项随机对照试验。

目的：近端固定在青少年特发性脊柱侧凸（AIS）手术是一个问题的讨论。所有螺钉（AS）结构比混合结构提供更好的冠状面矫正，但高位胸椎弓根螺钉放置可能具有挑战性。本研究调查了as结构是否比近端双钩爪（PH）结构提供更好的矫正。方法：2016年至2020年，接受后路脊柱融合术（PSF）的AIS患者随机分为as组或ph组，随访2年。主要结果是两年后主胸（MT） Cobb角矫正。次要结果是胸后凸（TK）、近端关节角（PJA）、近端胸角（PT） Cobb角、SRS-22r和两年后的并发症。结果：纳入60例患者（30例AS， 30例PH）。没有发现基线差异。术前MT Cobb角为62°±11°（AS） vs. 65°±12°（PH）。两年后MT Cobb角25°±9°（AS）与27°±7°（PH）无统计学差异（p = 0.247）。PT Cobb角分别为20°±9°（AS）和21°±9°（PH）， TK分别为23°±9°（AS）和22°±7°（PH）。两组的SRS-22r均有改善，差异无统计学意义：AS为3.9±0.5 ~ 4.3±0.5，PH为3.7±0.5 ~ 4.3±0.5。AS组并发症13例（10例），PH组并发症17例（13例），其中两组主要并发症1例（深创面感染）。结论：as结构在术后2年后仍不能提供更好的冠状Cobb矫正。对于近端固定的AIS患者，ph结构是一种可靠和安全的选择。编号：ntr-nl5552（2016）。试验注册：荷兰医学研究概述（OMON）： NL-OMON43852。

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来源期刊

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.