37. 主动顶点矫正技术对早期脊柱侧凸根尖调节的前瞻性研究

IF 2.5 Q3 Medicine

North American Spine Society Journal Pub Date : 2025-07-01 DOI:10.1016/j.xnsj.2025.100731

Ahmad Hammad MD , Arpit Sahu MBBS, MS , Bhavuk Garg MD , Mahmoud Hammad MD , Alaaeldin A. Ahmad MD

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引用次数: 0

摘要

背景背景主动尖端矫正术（APC）是一种后路固定技术，结合引导生长技术用于矫正早发性脊柱侧凸。APC包括在顶端近端（A1）和远端（A3）到大多数楔形椎体（A2）的凸侧插入系扎椎弓根螺钉，允许根据Hueter-Volkmann定律调节顶点。目的评估APC是否允许调节脊柱侧弯的根尖椎体。研究设计/设置：前瞻性研究。患者样本：采用APC治疗的早发性脊柱侧凸患者11例，术前和术后采用EOS成像技术测量凹凸高度。结果测量曲线特征包括Cobb角、椎体根尖平动（AVT）、T1-T12和T1-L5脊柱长度、椎体根尖凸和凹高度测量。方法对11例经APC治疗的早发性脊柱侧凸患者进行前瞻性研究，术前、术后应用EOS成像技术测量脊柱侧凸高度。排除随访患者<；2年来，缺少关于顶点调节的数据，APC不是主要的手术干预。结果平均年龄8.18±2.27岁，90%为先天性脊柱侧凸，术后平均随访2.36±0.51年。与术前相比，最终随访时，A1（从0.75到0.85，P=0.04）、A2（从0.71到0.78，P=0.04）、A3（从0.78到0.82，P=0.16）的凹/凸高度比增加，而未系扎椎体的凹/凸高度比减少（从1.00到0.97，P=0.06）。与未系扎椎体相比，A1和A2的统计学显著变化表明，APC后的凸侧和凹侧持续生长，其生长速度不同，从而调节了系扎椎体的部分，而不仅仅是最楔形的椎体。与术前相比，Cobb角、椎体根尖平移、T1-T12和T1-L5脊柱长度在即刻和最终随访时均有显著变化。结论sapc作为一种治疗早发性脊柱侧凸的手术技术，可以在曲率顶点处调节最楔形和邻近的椎体，同时通过生长引导保持整个脊柱的矫正。FDA器械/药物状态本摘要不讨论或包括任何适用的器械或药物。

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37. A prospective study on modulation of the apical vertebrae by active apex correction technique for early onset scoliosis

BACKGROUND CONTEXT

Active apex correction (APC) is posterior tethering technique in adjunct with guided growth for correction of early onset scoliosis. APC involves inserting tethering pedicle screws at convex side of apex proximal (A1) and distal (A3) to most wedged vertebra (A2) allowing modulation of apex according to Hueter-Volkmann law.

PURPOSE

To assess whether APC allows modulation of apical vertebrae of scoliotic curvature.

STUDY DESIGN/SETTING

Prospective study.

PATIENT SAMPLE

Eleven patients with early onset scoliosis treated by APC and evaluated by EOS imaging technique preoperatively and postoperatively to measure concave and convex heights.

OUTCOME MEASURES

Curve characteristics including Cobb angle, apical vertebral translation (AVT), spinal length T1-T12 and T1-L5, convex and concave height of apical vertebrae measurements.

METHODS

Prospective study including 11 patients with early onset scoliosis treated by APC and evaluated by EOS imaging technique preoperatively and postoperatively to measure concave and convex heights. Excluded patients with follow-up < 2years, missing data on apex modulation, and APC was not primary surgical intervention.

RESULTS

Mean age 8.18 ± 2.27 years, 90% congenital scoliosis and mean follow-up post-surgery 2.36 ± 0.51 years. Compared to preoperatively, concave/convex height ratio at the final follow up increased for A1 (from 0.75 to 0.85, P=0.04), A2 (from 0.71 to 0.78, P=0.04), A3 (from 0.78 to 0.82, P=0.16) but decreased for the untethered vertebra (from 1.00 to 0.97, P=0.06). The statistically significant change at A1 and A2 compared to untethered vertebrae indicates persistent growth in both convex and concave sides with a difference in growth rate following APC and thus modulation of the segment of tethered apical vertebrae, and not solely the most wedged vertebra. Compared to preoperatively, there was significant change in Cobb angle, apical vertebral translation, spinal length T1-T12 and T1-L5 at immediate and was maintained at final follow-up.

CONCLUSIONS

APC as a surgical technique for treatment of early onset scoliosis allowing modulation of the most wedged and adjacent vertebrae at the apex of the curvature, while preserving whole spine correction through growth guidance.