椎弓根螺钉和杆结构轴向平移技术矫正青少年特发性脊柱侧凸的结果
Outcome of Correction of Adolescent Idiopathic Scoliosis by the Axial Translational Technique With a Pedicle-Screw-and-Rod Construct.
摘要(中文译文)
青少年特发性脊柱侧凸（AIS）是儿科骨科实践中最常见的脊柱畸形类型，对于进展超过保守治疗阈值的侧凸，采用后路椎弓根螺钉构型进行手术矫治已成为参考标准。轴向平移技术（ATT）依赖于对畸形脊柱进行序贯去旋转并向预弯棒平移，避免了对侧凸节段施加强力的操作，而后者是较早的悬臂梁法和直接旋转法的特征。来自南亚中心描述该技术的数据仍然有限。我们于2021年9月至2024年3月在达卡国家创伤与骨科康复研究所（NITOR）开展了一项单中心、前瞻性准实验研究。连续纳入年龄10-18岁、确诊为AIS且主弯Cobb角大于45°的青少年患者。所有患者均采用ATT技术，使用多轴椎弓根螺钉和预弯5.5 mm钛棒行后路内固定与融合。主要结局为主要侧凸Cobb角和胸椎后凸角从基线至术后12个月的变化。次要结局为站立身高、视觉模拟量表（VAS）疼痛评分、脊柱侧凸研究学会-22（SRS-22）问卷以及改良Macnab标准的功能分级。酌情采用配对t检验和卡方检验；双侧P值小于0.05被认为具有统计学意义。共分析15例患者（平均年龄14.13 ± 2.06岁；女性占60.0%）。中胸段侧凸占多数（53.3%），Lenke 1型是最常见的类型（53.3%）。平均Cobb角从59 ± 7°矫正至10 ± 2°（平均绝对矫正48.8 ± 5.83°，矫正率83%；P < 0.001）。胸椎后凸从9 ± 2°改善至34.2 ± 3.43°（P < 0.001），表明向生理范围恢复。12个月时VAS评分从5.73 ± 0.77降至1.40 ± 0.48（P < 0.001），站立身高平均增加3 cm（P < 0.001）。SRS-22所有领域均显著改善（P < 0.001）。按改良Macnab标准评估的功能结局为：优9例（60.0%）、良4例（26.7%）、可2例（13.3%）；无患者评为差。3例患者（20.0%）共9枚螺钉在术后计算机断层扫描上显示影像学位置不良，但无临床后遗症；3例患者（20.0%）发生浅表伤口感染，经口服抗生素治疗后痊愈。采用椎弓根螺钉-棒内固定的ATT技术对AIS产生了显著的三维矫形效果，安全性良好，并在一年时在疼痛、外观和健康相关生活质量方面取得了有意义的改善。这些发现支持其作为资源受限三级中心可重复的矫形策略。
Abstract
Adolescent idiopathic scoliosis (AIS) is the most common form of spinal deformity encountered in paediatric orthopaedic practice, and surgical correction with posterior pedicle-screw constructs has become the reference standard for curves progressing beyond conservative thresholds. The axial translational technique (ATT) relies on sequential derotation and translation of the deformed spine toward a pre-contoured rod, avoiding the forceful segmental manoeuvres that characterise older cantilever and direct-rotation methods. Data describing this technique from South Asian centres remain limited. We conducted a single-centre, prospective quasi-experimental study at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, between September 2021 and March 2024. Adolescents aged 10-18 years with a confirmed diagnosis of AIS and a major Cobb angle greater than 45° were consecutively enrolled. All patients underwent posterior instrumentation and fusion using the ATT with polyaxial pedicle screws and a pre-bent 5.5 mm titanium rod. The primary outcomes were the change in the main-curve Cobb angle and thoracic kyphotic angle from baseline to 12 months post-operatively. Secondary outcomes were standing height, visual analogue scale (VAS) pain score, the Scoliosis Research Society-22 (SRS-22) questionnaire, and functional grading by Modified Macnab criteria. Paired t-tests and chi-square tests were used as appropriate; a two-sided P-value of less than .05 was considered statistically significant. Fifteen patients were analysed (mean age 14.13 ± 2.06 years; 60.0% female). Mid-thoracic curves predominated (53.3%), and Lenke type 1 was the most frequent pattern (53.3%). The mean Cobb angle was corrected from 59 ± 7° to 10 ± 2° (mean absolute correction 48.8 ± 5.83°, 83% correction; P < .001). Thoracic kyphosis improved from 9 ± 2° to 34.2 ± 3.43° (P < .001), representing restoration toward the physiological range. The VAS score fell from 5.73 ± 0.77 to 1.40 ± 0.48 at 12 months (P < .001), and standing height increased by a mean of 3 cm (P < .001). All SRS-22 domains improved significantly (P < .001). Functional outcome by Modified Macnab criteria was Excellent in 9 patients (60.0%), Good in 4 (26.7%), and Fair in 2 (13.3%); no patient was graded Poor. Nine screws in three patients (20.0%) were radiographically misplaced on post-operative computed tomography without clinical sequelae; three patients (20.0%) developed superficial wound infection that resolved with oral antibiotics. The ATT with pedicle-screw-and-rod instrumentation produced substantial three-dimensional correction of AIS with a favourable safety profile and meaningful gains in pain, appearance, and health-related quality of life at one year. These findings support its use as a reproducible correction strategy in resource-constrained tertiary centres.
如何引用
AMA
Md Rajib Mahmud, A H M Masiur Rahman, Golam Mahmud, Sk Muhammad Atiqur Rahman, Nadia Hossain, Shagor Kumer Sarker, et al. Outcome of Correction of Adolescent Idiopathic Scoliosis by the Axial Translational Technique With a Pedicle-Screw-and-Rod Construct.. Cureus. 2026; doi:10.7759/cureus.109909.
APA
Md Rajib Mahmud, A H M Masiur Rahman, Golam Mahmud, Sk Muhammad Atiqur Rahman, Nadia Hossain, Shagor Kumer Sarker, et al (2026). Outcome of Correction of Adolescent Idiopathic Scoliosis by the Axial Translational Technique With a Pedicle-Screw-and-Rod Construct.. Cureus. https://doi.org/10.7759/cureus.109909
GB/T 7714
Md Rajib Mahmud, A H M Masiur Rahman, Golam Mahmud, Sk Muhammad Atiqur Rahman, Nadia Hossain, Shagor Kumer Sarker, et al. Outcome of Correction of Adolescent Idiopathic Scoliosis by the Axial Translational Technique With a Pedicle-Screw-and-Rod Construct.[J]. Cureus, 2026 doi:10.7759/cureus.109909.
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