مقایسه‌ی نتایج درمانی اسکولیوز با منشأ ناشناخته در نوجوانان به دو روش Hybrid Fixation و All-Pedicle-Screw

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشیار، گروه ارتوپدی، دانشکده‌ی پزشکی و بیمارستان الزهرا (س)، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دستیار، گروه ارتوپدی، دانشکده‌ی پزشکی و بیمارستان الزهرا (س)، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: این مطالعه با هدف مقایسه‌ی تأثیر دو روش All-pedicle-screw و Hybrid fixation در بهبود اسکولیوز با منشأ ناشناخته‌ی سن بلوغ انجام شد.روش‌ها: در یک مطالعه‌ی هم‌گروهی، 40 بیمار تحت درمان با روش All-pedicle-screw تحت عمل جراحی قرار گرفتند و نتایج عمل بر اساس بررسی معیارهای رادیولوژیک (میزان اصلاح Major cobb’s angle) و پرسش‌نامه‌ی Scoliosis research society-30 (SRS-30) با یافته‌های حاصل از عمل 40 بیمار مشابه با روش Hybrid fixation در دو سال بعد از عمل مقایسه گردید.یافته‌ها: میانگین درصد اصلاح زاویه‌ی انحنا در دو گروه All-pedicle-screw و Hybrid fixation به ترتیب 7/82 و 3/76 درصد بود و میزان اصلاح زاویه در گروه All-pedicle-screw، به طور معنی‌داری بیشتر بود (044/0 = P). بر اساس پرسش‌نامه‌ی SRS-30، کلیه‌ی شاخص‌ها در گروه All-pedicle-screw به طور معنی‌داری بهبود پیدا کرد، اما در گروه All-pedicle-screw، شاخص‌های تصویر ذهنی فرد از خود و رضایتمندی از درمان، مطلوب‌تر از گروه Hybrid fixation بود (001/0 > P).نتیجه‌گیری: هر دو روش All-pedicle-screw و Hybrid fixation در اصلاح زاویه‌ی انحنا مؤثر بودند، اما میزان اصلاح در روش All-pedicle-screw مطلوب‌تر بود و بیماران عمل شده با این روش، تصویر ذهنی از خود و رضایتمندی بیشتری نسبت به گروه Hybrid fixation داشتند.

کلیدواژه‌ها


عنوان مقاله [English]

Evaluation of Surgical Outcome of All-Pedicle-Screw versus Hybrid Fixation in Patients with Adolescent Idiopathic Scoliosis

نویسندگان [English]

  • Mohammadreza Etemadifar 1
  • Pouya Rajabzadeh 2
  • Hadi Ravanbod 2
1 Associate Professor, Department of Orthopedic Surgery, School of Medicine AND Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
2 Resident, Department of Orthopedic Surgery, School of Medicine AND Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: The aim of current study was to compare the effects of all-pedicle-screw versus hybrid fixation techniques in surgical correction of adolescent idiopathic scoliosis.Methods: This clinical-trial study conducted on 40 patients who underwent corrective scoliosis surgery using all-pedicle-screw technique. Surgical outcome was assessed using radiological criteria (major Cobb’s angle correction) and Scoliosis Research Society-30 (SRS-30) questionnaire with measurements done before and two years after surgery. Findings were compared with results of 40 similar patients’ outcomes found in another study with hybrid fixation technique.Findings: Mean correction of Cobb’s angle in all-pedicle-screw and hybrid fixation groups was 82.7 and 76.3 percent, respectively. Rate of correction was significantly higher in all-pedicle-screw group (P = 0.044). Based on SRS-30 questionnaire, all domains scores were significantly improved in all-pedicle-screw group and in comparison to hybrid fixation, this method was only significantly better in patients' personal image/appearance and satisfaction domains (P < 0.001).Conclusion: Both techniques of pedicle screw and hybrid fixation are effective in correction of scoliosis, but this correction is more desirable in all-pedicle-screw group. Patients who had undergone all-pedicle-screw technique in comparison to hybrid fixation showed higher rate of satisfaction from surgery and personal image/appearance.

کلیدواژه‌ها [English]

  • Scoliosis
  • Puberty
  • Skeletal fixation
  • Pedicle screws
  1. Rafi S, Munshi N, Abbas A, Shaikh RH, Hashmi I. Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery. J Neurosci Rural Pract 2016; 7(4): 550-3.
  2. Baker ADL. Treatment of scoliosis correction and internal fixation by spine instrumentation. In: Banaszkiewicz PA, Kader DF, editors. Classic papers in orthopaedics. New York, NY: Springer; 2018. p. 273-5.
  3. Etemadifar M, Mahmoodian A, Mahnam F. The results of the surgical treatment of idiopathic adolescent scoliosis. J Isfahan Med Sch 2009; 27(97): 365-71. [In Persian].
  4. Harrington PR. The management of scoliosis by spine instrumentation: An evaluation of more than 200 cases. South Med J 1963; 56: 1367-77.
  5. Kim YJ, Lenke LG, Cho SK, Bridwell KH, Sides B, Blanke K. Comparative analysis of pedicle screw versus hook instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2004; 29(18): 2040-8.
  6. Barr SJ, Schuette AM, Emans JB. Lumbar pedicle screws versus hooks. Results in double major curves in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 1997; 22(12): 1369-79.
  7. Suk SI, Lee CK, Min HJ, Cho KH, Oh JH. Comparison of Cotrel-Dubousset pedicle screws and hooks in the treatment of idiopathic scoliosis. Int Orthop 1994; 18(6): 341-6.
  8. Yu CH, Chen PQ, Ma SC, Pan CH. Segmental correction of adolescent idiopathic scoliosis by all-screw fixation method in adolescents and young adults. Minimum 5 years follow-up with SF-36 questionnaire. Scoliosis 2012; 7: 5.
  9. Yilmaz G, Borkhuu B, Dhawale AA, Oto M, Littleton AG, Mason DE, et al. Comparative analysis of hook, hybrid, and pedicle screw instrumentation in the posterior treatment of adolescent idiopathic scoliosis. J Pediatr Orthop 2012; 32(5): 490-9.
  10. Kim YJ, Lenke LG, Kim J, Bridwell KH, Cho SK, Cheh G, et al. Comparative analysis of pedicle screw versus hybrid instrumentation in posterior spinal fusion of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2006; 31(3): 291-8.
  11. Lamartina C, Petruzzi M, Macchia M, Stradiotti P, Zerbi A. Role of rod diameter in comparison between only screws versus hooks and screws in posterior instrumentation of thoracic curve in idiopathic scoliosis. Eur Spine J 2011; 20(Suppl 1): S85-S89.
  12. Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FY, et al. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: A comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976) 2007; 32(4): 448-52.
  13. Vora V, Crawford A, Babekhir N, Boachie-Adjei O, Lenke L, Peskin M, et al. A pedicle screw construct gives an enhanced posterior correction of adolescent idiopathic scoliosis when compared with other constructs: Myth or reality. Spine (Phila Pa 1976) 2007; 32(17): 1869-74.
  14. Campble, scoliosis and kyphosis, operative treatment, Volume two, twelfth edition 1720-1733, 2013.
  15. Cecen GS, Gulabi D, Guclu B, Cecen DA, Oltulu I. Comparison of pedicle screw fixation and hybrid instrumentation in adolescent idiopathic scoliosis. Acta Orthop Traumatol Turc 2016; 50(3): 351-5.
  16. Jaquith BP, Chase A, Flinn P, Sawyer JR, Warner WC, Freeman BL, et al. Screws versus hooks: Implant cost and deformity correction in adolescent idiopathic scoliosis. J Child Orthop 2012; 6(2): 137-43.
  17. Karatoprak O, Unay K, Tezer M, Ozturk C, Aydogan M, Mirzanli C. Comparative analysis of pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery. Int Orthop 2008; 32(4): 523-8.
  18. Hwang SW, Samdani AF, Wormser B, Amin H, Kimball JS, Ames RJ, et al. Comparison of 5-year outcomes between pedicle screw and hybrid constructs in adolescent idiopathic scoliosis. J Neurosurg Spine 2012; 17(3): 212-9.
  19. Crawford AH, Lykissas MG, Gao X, Eismann E, Anadio J. All-pedicle screw versus hybrid instrumentation in adolescent idiopathic scoliosis surgery: a comparative radiographical study with a minimum 2-Year follow-up. Spine (Phila Pa 1976) 2013; 38(14): 1199-208.
  20. Di Silvestre M, Bakaloudis G, Lolli F, Vommaro F, Martikos K, Parisini P. Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80 degrees: Pedicle screws versus hybrid instrumentation. Eur Spine J 2008; 17(10): 1336-49.