| 【Background】Adolescent idiopathic scoliosis is early youth or skeletal maturity before spinal deformity. In different types of scoliosis deformity, adolescent idiopathic scoliosis is the most common, accounting for 80% of the whole scoliosis.For mild(Cobb < 40 °) adolescent patients with scoliosis, generally use the conservative treatment, such as support for the moderate or severe scoliosis, should be better to choose surgery. Posterior pedicle screw fixation orthopedics surgery is the most widely used, won a good corrective effect. To increase the number of pedicle screw nailing, can increase the anchor point, improve the orthopedic force, but also increased medical costs. Therefore, how to obtain the density of nailing and balance of orthopedic effect, for the surgical treatment of patients with idiopathic scoliosis, has important clinical significance.At the same time, teenagers and adults ages of scoliosis is not only a physical deformity, more impact on patients quality of life and psychological. As the change of medical model and health related quality of life research, development, more and more scholars realized the surgical correction rate is not the higher the better, patients with AIS treatment should be in pursuit of the improvement of the quality of life as the ultimate goal. However, for patients with idiopathic scoliosis with different density of orthopaedic surgery, nailing has significant effects on whether the quality of life, it is lack of related research.In view of the above situation, this topic proposed retrospective analysis posterior accept pedicle nailing between orthopaedic Lenke1 idiopathic scoliosis patients with preoperative, postoperative and 5 years follow-up imaging data, using interval nailing line 3 d corrective scoliosis surgery effect; On this basis, at the same time using pedicle screws line nailing scoliosis orthopaedic surgery patients for comparison, analysis of different orthopaedic surgery impact on patients quality of life. [Objectives]1. To evaluate the outcome of surgical treatment for flexible idiopathic scoliosis using interval pedicle screw fixation with more than 5 years follow-up.2. To investigate the interval pedicle screw fixation and all pedicle screw fixation differences of patient outcome in postoperative IS patients using the SRS-22 questionnsire. [Method]1. Fifty-one idiopathic scoliosis patients with spine curves<75° and flexibility>40% were performed correction surgery with interval pedicle screw fixation. The parameters of main curve Cobb angle, rotation of apical vertebra, coronal and sagittal balance preoperatively, postoperatively immediately and at final follow-up were analyzed. The operation time, blood loss and complications were also recorded.2. 46 IS patients who were treated with surgery were separated into two groups(interval pedicle screw fixation, all pedicle screw fixation).There were 26 patients in interval pedicle screw fixation group and 20 patients in all pedicle screw fixation group. All patients’ average fellow-up was 5.1 years. There were no statistically significant differences between the groups for gender,age,main curve location,preoperative and postoperative main curve Cobb angle(P>0.05).But there were significant differences for blood loss and cost of operation. [Results]1. The main curve Cobb angle decreased significantly from 53.6°±6.6°preoperatively to 15.8°±7.4° immediately after surgery, at the final follow-up, the mean Cobb angle was 17.7°±6.1°. Rotation of the apical vertebra was corrected from 21.4°±7.1° preoperatively to 9.6°±3.0° postoperatively and was 17.7°±6.1° at final follow-up. The coronal distance from C7 plumbline to CSVL were 6.3mm±11.2mm,-3.7mm±8.0mm and-3.9mm±5.5mm preoperatively, postoperatively and at final follow-up, respectively. The sagittal distance from C7 plumbline to SSVL were-13.3mm±10.7mm,-2.1 mm±5.2mm and-2.9mm±5.0mm, respectively. These radiological parameters were significant different between preoperatively and postoperatively immediately(P<0.05), and there were no difference between postoperatively immediately and at final follow-up(P>0.05). 2 patients complicated with implant failures. An adding-on phenomenon was detected in 3 patients and 1 patients had postoperative superficial wound infections. The mean blood loss during surgery was 825 ml and the mean operation time was 155 minutes. Compared with conventional methods, the interval pedicle screw fixation decreased up to 52% fewer screws.2. There were significant differences in the scores in the five domains of the two groups’ prooperation and immediate postoperation,postoperation after 5 years respectively(P>0.05).There were no significant differentces between the immediate postoperation and postoperation 5 years(P > 0.05). With regard to individual items,there were no significant differences in the scores between the 2 groups. [Conclusions]1. Interval pedicle screw fixation of flexible idiopathic scoliosis showed satisfactory results. This technique has several advantages, including shorter operation time, reduced blood loss, and with less cost.2. After Mid- to Long-Term follow-up,there were significant progress of the postoperation’ scrow in the patients using interval pedicle screw fixation compare with the preoperation’s.The interval pedicle screw fixation have vast space to be used. |
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