椎体栓系是否会导致邻近非固定水平的冠状动脉活动过度?初步研究。

IF 1.5 3区 医学 Q3 ORTHOPEDICS
Journal of Pediatric Orthopaedics Pub Date : 2025-08-01 Epub Date: 2025-06-19 DOI:10.1097/BPO.0000000000002959
Hans K Nugraha, Todd A Milbrandt, A Noelle Larson
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引用次数: 0

摘要

背景:腰椎与L2及以下的下固定椎体(LIV)融合可导致未融合节段的活动能力增加或活动过度,可能导致早期椎间盘和关节磨损以及随后的退行性关节炎。椎体系扎术(VBT)是一种用于脊柱侧凸的运动保持手术,但对于离LIV远端的未固定节段,没有数据表明其对椎间盘运动的影响。我们假设VBT保留了AIS患者离LIV远端的冠状弧运动,而不会出现融合手术后观察到的运动过度。方法:对接受VBT治疗的青少年特发性脊柱侧凸患者进行单中心回顾性分析。站立弯曲片作为术前和术后1年的标准护理收集,根据机构协议最大限度地减少侧弯。如先前文献所述,为了评估冠状运动弧,从椎间盘直接远端到LIV-S1,在每个水平测量椎间角的x线摄影测量。结果:共有95例患者进行了临床术前和术后弯曲x线片,并纳入研究。总共测量了2086个节段。16例患者行双侧系扎术,分别进行分析。与术前相同水平的值相比,配对t检验显示远端未置入节段的冠状运动弧无显著差异。结论:VBT术后未固定节段保持了正常的侧弯节段运动。与融合术相比,没有证据表明脊柱侧凸患者在VBT后会出现腰椎活动过度。这为保留正常运动提供了早期证据,可以防止邻近节段疾病和长融合的早期关节炎报道。证据等级:iii级回顾性队列研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Does Vertebral Body Tethering Cause Coronal Hypermobility at Adjacent Noninstrumented Levels? A Preliminary Study.

Background: Fusion into the lumbar spine with lower instrumented vertebra (LIV) of L2 and below can result in increased mobility or hypermobility of the unfused segments, potentially contributing to early disk and joint wear and subsequent degenerative arthritis. Vertebral body tethering (VBT) is a motion-preserving surgery for scoliosis, but no data is available about its effect on disk motion for the uninstrumented segments distal to the LIV. We hypothesize that VBT preserves the coronal arc of motion distal to the LIV in AIS patients without the development of hypermobility which has been observed following fusion surgery.

Methods: A single-center retrospective review was completed of adolescent idiopathic scoliosis patients who underwent VBT. Standing bending films were collected as standard of care preoperatively and at 1-year postoperatively with maximum effort on side bending according to an institutional protocol. To evaluate the coronal arc of motion, radiographic measurement of the intervertebral angles was measured at each level from the disk directly distal to LIV-S1, as described in previous literature.

Results: A total of 95 patients had clinical preoperative and postoperative bending radiographs and were included in the study. In total, there were 2086 segments measured. Sixteen patients had bilateral tether procedures and were analyzed separately. Compared with preoperative values over the same levels, paired t test showed no significant difference in the coronal arc of motion for the distal uninstrumented segments.

Conclusions: Normal segmental motion on lateral bend was preserved on the noninstrumented segments following VBT. In contrast to fusion, there was no evidence of lumbar hypermobility following VBT in scoliosis patients. This provides early evidence for preserved normal motion which could be protective against adjacent segment disease and early arthritis reported with long fusions.

Level of evidence: Level III-retrospective cohort study.

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来源期刊
CiteScore
3.30
自引率
17.60%
发文量
512
审稿时长
6 months
期刊介绍: ​Journal of Pediatric Orthopaedics is a leading journal that focuses specifically on traumatic injuries to give you hands-on on coverage of a fast-growing field. You''ll get articles that cover everything from the nature of injury to the effects of new drug therapies; everything from recommendations for more effective surgical approaches to the latest laboratory findings.
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