摘要目的 探讨经第2骶椎骶髂螺钉(second sacral alar-iliac,S2AI)固定骨盆技术在成人脊柱侧后凸畸形患者后路矫形术中的可行性,并评估其临床疗效及并发症情况.方法 收集2013年9月至2014年10月12例应用S2AI技术进行成人脊柱侧后凸矫形患者的病历资料,男2例,女10例;年龄23～66岁,平均(49.4±15.4)岁.所有患者均测量术前、术后及末次随访时侧凸Cobb角、冠状面平衡(C7 plumb line-center sacral vertical line,C7PL-CSVL)、骨盆倾斜、局部后凸(regional kyphosis,RK)Cobb角及矢状面平衡(sagittal vertical axis,SVA);初诊及随访时均填写SF-36量表.比较患者术前、术后及末次随访时的影像学差异及疗效评价差异.结果 12例随访时间为(15.8±3.8)个月.术前侧凸Cobb角为57.2°±16.6°,术后为25.6°±14.8°,较术前有明显改善,平均矫正率为56.9％±19.4％,末次随访为26.1°±15.0°,随访中未见明显矫正丢失;术前、术后C7PL-CSVL分别为(29.9±16.2) mm、(15.8±10.5) mm,术后改善明显,末次随访为(13.0±9.1)mm,维持良好;术前、术后骨盆倾斜分别为5.0°±2.2°与1.7°±1.9°,术后骨盆倾斜有明显改善,平均矫正率为70.9％±24.5％,末次随访时维持良好,平均为1.4°±1.3°.局部后凸Cobb角术前为42.2°±23.4°,术后为5.1°±25.6°,术后有明显改善),末次随访时未见明显丢失,平均为5.9°±24.5°;SVA由术前(31.0±9.9) mm减小至术后(10.6±4.6) mm,末次随访平均为(11.0±4.4) mm,亦无明显矫正丢失.12例患者术中均无SEP及MEP信号的改变或丢失.术后1例1枚螺钉位置偏上穿出上终板,1例1枚螺钉位置较偏内,但无神经损害,随访中愈合良好.结论 应用S2AI螺钉固定技术治疗成人脊柱侧后凸畸形既满足坚强固定的需要,又可纠正骨盆倾斜,矫形效果满意.

abstractsObjective To evaluate the feasibility and clinical outcomes of second sacral alar-iliac (S2AI) technique utilized in adult patients with kyphoscoliosis.Methods 12 patients (2 males and 10 females) applying second sacral alar-iliac screws from September 2013 to October 2014 were retrospectively reviewed.The average age of the cohort was (49.4±15.4) years (range,23-66 years).The coronal parameters including Cobb angle and distance between C7 plumb line and center sacral vertical line (C7PL-CSVL),as well as the sagittal parameters including regional kyphosis (RK) and sagittal vertical axis (SVA) were measured pre-operatively,post-operatively and last follow-up.The Short Form-36 Health Survey (SF-36) were fulfilled at pre-operation and each follow-up.Results The average follow-up period was (15.8±3.8) months.The pre-operative and post-operative Cobb angles were 57.2°± 16.6° and 25.6± 14.8°,of which difference was significant.The correction rate of Cobb angle was 56.9％± 19.4％.The pre-operative,post-operative and last follow-up pelvic obliquity were 5.0°±2.2°,1.7°± 1.9° and 1.4°± 1.3°.The significant improvement was obtained postoperatively.The pre-operative,post-operative and last follow-up C7PL-CSVL were (29.9±16.2) mm,(15.8± 10.5) mm and (13.0±9.1) mm.Significant post-operative improvement was observed while there was no change at last follow-up.Post-operative RK significantly improved from 42.2°±23.4° to 4.9°±24.0°.SVA decrease significantly from pre-operative (36.5±28.0) mm to post-operative (18.5±17.0) mm.The average RK and SVA were 4.9°±24.0° and (34.2±17.5) mm in last follow-up,and no loss of correction were found.Conclusion The S2AI fixation used in adult patients with kyphoscoliosis deformity could produce excellent correction of pelvic obliquity and obtain satisfied clinical outcomes.