PDF(Pubmed)
Abstract：
The restoration of sagittal alignment is fundamental to the surgical correction of adolescent idiopathic scoliosis (AIS). Despite established techniques, some patients present with inadequate postoperative thoracic kyphosis (TK), which may increase the risk of proximal junctional kyphosis (PJK) and imbalance. There is a lack of knowledge concerning the effectiveness of patient-specific rods (PSR) with measured sagittal curves in achieving a TK similar to that planned in AIS surgery, the factors influencing this congruence, and the incidence of PJK after PSR use. This is a systematic review of all types of studies reporting on the PSR surgical correction of AIS, including research articles, proceedings, and gray literature between 2013 and December 2023. From the 28,459 titles identified in the literature search, 81 were assessed for full-text reading, and 7 studies were selected. These included six cohort studies and a comparative study versus standard rods, six monocentric and one multicentric, three prospective and four retrospective studies, all with a scientific evidence level of 4 or 3. They reported a combined total of 355 AIS patients treated with PSR. The minimum follow-up was between 4 and 24 months. These studies all reported a good match between predicted and achieved TK, with the main difference ranging from 0 to 5 degrees, p > 0.05, despite the variability in surgical techniques and the rods\' properties. There was no proximal junctional kyphosis, whereas the current rate from the literature is between 15 and 46% with standard rods. There are no specific complications related to PSR. The exact role of the type of implants is still unknown. The preliminary results are, therefore, encouraging and support the use of PSR in AIS surgery.
摘要：
恢复矢状面对准是青少年特发性脊柱侧凸（AIS）手术矫正的基础。尽管有既定的技术，一些患者出现术后胸椎后凸畸形（TK），这可能会增加近端交界性脊柱后凸（PJK）和失衡的风险。缺乏关于患者特异性杆（PSR）与测量矢状曲线在实现类似于AIS手术中计划的TK方面的有效性的知识。影响这种一致性的因素，以及PSR使用后PJK的发生率。这是对PSR手术矫正AIS的所有类型研究的系统评价，包括研究文章，诉讼程序,2013年至2023年12月之间的灰色文献。从文献检索中确定的28,459个标题中，81人被评估为全文阅读，并选择了7项研究。其中包括六项队列研究和一项与标准棒的比较研究，六个单中心和一个多中心，三项前瞻性研究和四项回顾性研究，所有的科学证据水平都是4或3。他们报告了总共355例接受PSR治疗的AIS患者。最短随访时间为4至24个月。这些研究都报道了预测和实现的传统知识之间的良好匹配，主要差异在0到5度之间，p>0.05，尽管手术技术和棒的特性存在差异。没有近端交界性脊柱后凸,而目前来自文献的比率在15%到46%之间，使用标准棒。没有与PSR相关的特定并发症。植入物类型的确切作用仍然未知。初步结果是,因此,鼓励和支持PSR在AIS手术中的使用。
