Rib hump deformity assessment using the rib index in adolescent idiopathic scoliotics treated with full screw or hybrid constructs: aetiological implications.

Scoliosis Pub Date : 2015-02-11 eCollection Date: 2015-01-01 DOI:10.1186/1748-7161-10-S2-S10
Konstantinos C Soultanis, Nikolaos A Stavropoulos, Theodoros B Grivas, Konstantinos Tsiavos, Konstantinos Starantzis, Panayiotis J Papagelopoulos
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引用次数: 2

Abstract

Background: Review of literature reveals that in Idiopathic Scoliosis (IS) children, the post-operative rib hump (RH) correction using full transpedicular screw construct has never been compared to hybrid constructs, applying the Rib-Index (RI) method. Therefore the aim of this report is to study which of the above two constructs offers better postoperative Rib Hump Deformity (RHD) correction.

Methods: Twenty five patients with Adolescent Idiopathic Scoliosis (AIS) were operated using full pedicle screw construct or hybrid construct. Sixteen underwent full screw instrumentation (group A) and nine an hybrid one (group B). The median age for group A was 15 years and for group B 17.2 years. The RHD was assessed on the lateral spinal radiographs using the RI. The RI was calculated by the ratio of spine distances d1/d2, where d1 is the distance between the most extended point of the most extending rib contour and the posterior margin of the corresponding vertebra on the lateral scoliosis films and d2 is the distance from the least projected rib contour and the posterior margin of the same vertebra. Moreover the amount of RI correction was calculated by subtracting the post-operative RI from the pre-operative RI.

Results: Although within group A the RI correction was statistical significant (the pre-op RI was 1.93 and the post-op 1.37; p<0.001) and similarly in group B (the mean pre-op RI was 2.06 while the mean post-op 1.51; p=0.008), between group A and B the post-operative RI correction mean values were found to be no statistically significant, (p=0.803).

Conclusion: Although the pre- and post-operative RI correction was statistically significant within each group, this did not happen post-operatively between the two groups. It appears that the RHD correction is not different, no matter what the spinal construct type was used. Provided that the full screw construct is powerful, the post-operative derotation and RHD correction was expected to be better than when an hybrid construct is applied, which is not the case in this study. It is therefore implied that the RHD results more likely from the asymmetric rib growth rather than from vertebral rotation, as it has been widely believed up to now. In 2013 Lykissas et al, reported that costoplasty combined with pedicle screws and vertebral derotation significantly improved RH deformity as opposed to pedicle screws and vertebral derotation alone. Another interesting implication is that the spinal deformity is the result of the thoracic asymmetry, implication in line with the late Prof. John Sevastikoglou's (Sevastik's) thoracospinal concept.

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用肋骨指数评估青少年特发性脊柱侧凸全螺钉或混合结构治疗的肋骨驼峰畸形:病因学意义。
背景:文献回顾显示,在特发性脊柱侧凸(IS)儿童中,使用全经椎弓根螺钉结构的术后肋骨隆起(RH)矫正从未与使用肋骨指数(RI)方法的混合结构进行比较。因此,本报告的目的是研究上述两种结构中哪一种能更好地矫正术后肋骨驼峰畸形(RHD)。方法:对25例青少年特发性脊柱侧凸(AIS)患者采用全椎弓根螺钉固定或混合固定进行手术治疗。全螺钉内固定16例(A组),混合螺钉内固定9例(B组)。A组的中位年龄为15岁,B组的中位年龄为17.2岁。在侧位脊柱x线片上使用RI评估RHD。RI由脊柱距离的比值d1/d2计算,其中d1为侧侧侧凸片上最延伸肋骨轮廓最延伸点与相应椎体后缘之间的距离,d2为最小投影肋骨轮廓与同一椎体后缘之间的距离。此外,通过术前RI减去术后RI来计算RI校正量。结果:虽然在A组内,RI校正具有统计学意义(术前RI为1.93,术后RI为1.37;结论:尽管两组患者术前和术后的RI矫正均有统计学意义,但两组患者术后的RI矫正均无统计学意义。无论使用何种脊柱构造类型,RHD矫正似乎没有什么不同。如果全螺钉结构强大,则预期术后旋转和RHD矫正优于混合结构,但在本研究中并非如此。因此,这意味着RHD更可能是由不对称的肋骨生长引起的,而不是像目前普遍认为的那样是由椎体旋转引起的。2013年Lykissas等人报道,与单独使用椎弓根螺钉和椎体旋转相比,胸骨成形术联合椎弓根螺钉和椎体旋转可显著改善RH畸形。另一个有趣的暗示是,脊柱畸形是胸部不对称的结果,这与已故的John Sevastikoglou教授(Sevastik)的胸椎概念一致。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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