| Object:To compare the treatment results between all segmental pedicle screws(ASPS) and selective segmental pedicle screws(SSPS).Method:A retrospective study of 48 severe rigid adolescent idiopathic scoliosis(AIS) patients with only posterior pedicle screws instrumentation and fusion during March 2003 to December 2008 in our department was made. Patients with a major thoracic curve>70°and flexibility<30% in anteroposterior standing radiograph and supine bending radiograph were screened. There were 48 patients suitable for this study selected from a total of 327 AIS ones. Of them,22 cases(12 males,10 females) who were admitted in our hospital most before October 2005 were fixed with SSPS that is all the internal fixations were pedicle screws placed according to the principal of Cotrel-Dubousset(CD) or key vertebra, the other 26 cases (7 males,19 females) who were admitted in our hospital most after October 2005 were fixed with ASPS that is all the vertebra in the fusion segments were fixed with pedicle screws in the concave side or both sides. Both groups had comparabilities in Cobb angles of major thoracic curve and thoracic(T5-12) kyphosis, in the difference between both soft tissues high over acromial regions and trunk shift in appearance. Each data were under normality test and homogeneity test for variance, and the positive one were under studernt test,others were under Wilcoxon rank sum test.Result:With student test or Wilcoxon rank sum test, the data of two groups were under statistical comparison as follows:Pre-op:There were no significant difference between ASPS and SSPS groups in major thoracic curves(t=-0.206, P=0.838), spine flexibility (t=-1.453, P=0.153), the difference between both soft tissues high over acromial regions (u=0.166, P=0.869), the maximum ratio of bilateral trunk width in out view (t-0.731, P=0.469), the Cobb angle of thoracic kyphosis in normal thoracic kyphosis (t=0.296, P=0.776) and hyperkyphosis(>40°)(t=0.312, P=0.757) patients. And there were significant difference between the two groups in operation age (u=2.659, P=0.008) and the distance between the middle line of neck and pelvis (t=2.522, P=0.015).During-op:There were no significant difference between the two groups in blood lost (t=2.004, P=0.051) and operation time(t=0.551, P=0.584).Post-op:There were no significant difference between the two groups in the changes of both soft tissues high difference over acromial regions one week after operation (t=-1.174, P=0.246) or the last follow-up (u=0.507, P=0.612), of the distance between the middle lines of neck and pelvis one week after operation (u=1.366, P=0.172) or the last follow-up (u=1.945, P=0.052) and of the thoracic kyphosis angle of normal thoracic kyphosis patients one week after operation (t=-0.497, P=0.347) or the last follow-up (t=0.302, P=0.772) Contrarily, there were significant difference between the two groups in the changes of thoracic kyphosis angle of thoracic hyperkyphosis patients one week after operation (t=-3.245, P=0.003) or the last follow-up (t=-2.627, P=0.013) and the corrective rate of major thoracic curve one week after operation(u=3.280,P=0.001). There were no lose of corrective rate of major thoracic curve in a mean of 6mon-4.5y follow-up expect for the 19th patient in ASPS group whose convex rod was broken.Conclusion:There had a higher postoperative correction rate of major thoracic curve and thoracic hyperkyphosis of severe rigid AIS in ASPS group than in SSPS group. And there were no significant difference in the change of both soft tissues high over acromial regions and the maximum ratio of bilateral trunk of out view. It's necessary to fixed with ASPS when treated severe rigid AIS surgery.
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