Tsirikos Athanasios I, Lipton Glen, Chang Wei-Ning, Dabney Kirk W, Miller Freeman
Department of Orthopaedics, Alfred I. duPont Hospital for Children, Wilmington, DE 19899, USA.
Spine (Phila Pa 1976). 2008 May 1;33(10):1133-40. doi: 10.1097/BRS.0b013e31816f63cf.
STUDY DESIGN: Retrospective clinical and radiographic consecutive case series of 2 surgeons. OBJECTIVE: The purpose of this study was to present a large consecutive series of patients with cerebral palsy who were treated with the Unit rod instrumentation at a single institution. The goal was to report the incidence of surgical complications, degree of deformity correction, reoperation rate, prevalence of pseudarthrosis, and the caretakers' perceived outcome. SUMMARY OF BACKGROUND DATA: Children with cerebral palsy frequently develop scoliosis that requires surgical correction. Segmental instrumentation has been the primary mode of treatment. There are no reported large series with long-term follow up. METHODS: This study was a retrospective review of 287 children treated with the Unit rod instrumentation. This instrumentation with fusion included the whole spine (between C7 and T3 into the pelvis) with 242 posterior-only and 45 anterior-posterior procedures. Of this group, 241 patients were observed for more than 2 years. This review focused on the rate of complications and radiographic outcome of the treatment. Parent and caretaker interviews were conducted to define perceived functional outcome after surgery. RESULTS: Scoliosis was corrected from a mean of 76 degrees to 25 degrees (68%). Pelvic obliquity was corrected from a mean of 17 degrees to 5 degrees (71%). In posterior-only procedures the average blood loss was 2.8 L, ICU stay was 4.9 days, and the hospital stay was 19.6 days. In combined procedures, the average blood loss was 3.4 L, ICU stay was 6.7 days, and the hospital stay was 24.5 days. Major complications included 3 perioperative deaths, 18 deep wound infections [12 early deep infections in a total of 287 patients (4.2%); 6 late deep infections in a total of 236 patients (2.5%)], and 2 patients with septicemia who recovered after prolonged antibiotic management. Caretakers' survey reported a 96% satisfaction rate. CONCLUSION: The Unit rod instrumentation is a common standard technique and the primary instrumentation system for the treatment of pediatric patients with cerebral palsy and neuromuscular scoliosis because it is simple to use, it is considerably less expensive than most other systems, and can achieve good deformity correction with a low loss of correction, as well as a low prevalence of associated complications and a low reoperation rate.
研究设计：两位外科医生的回顾性临床和影像学连续病例系列研究。 目的：本研究旨在展示在单一机构接受单位棒器械治疗的大量连续性脑瘫患者系列。目标是报告手术并发症的发生率、畸形矫正程度、再次手术率、假关节形成的发生率以及护理人员对治疗效果的感知。 背景数据总结：脑瘫患儿常发生脊柱侧弯，需要手术矫正。节段性器械固定一直是主要的治疗方式。目前尚无关于长期随访的大型系列报道。 方法：本研究是对287例接受单位棒器械治疗的儿童进行的回顾性分析。这种融合器械固定包括整个脊柱（从C7到T3直至骨盆），其中242例仅采用后路手术，45例采用前后路联合手术。在这组患者中，241例患者接受了超过2年的观察。本分析重点关注治疗的并发症发生率和影像学结果。通过对家长和护理人员的访谈来确定术后的功能效果感知。 结果：脊柱侧弯平均从76度矫正至25度（矫正率68%）。骨盆倾斜平均从17度矫正至5度（矫正率71%）。仅后路手术的平均失血量为2.8升，重症监护病房（ICU）住院时间为4.9天，住院时间为19.6天。联合手术的平均失血量为3.4升，ICU住院时间为6.7天，住院时间为24.5天。主要并发症包括3例围手术期死亡、18例深部伤口感染[287例患者中有12例早期深部感染（4.2%）；236例患者中有6例晚期深部感染（2.5%）]，以及2例败血症患者，经长期抗生素治疗后康复。护理人员的调查显示满意度为96%。 结论：单位棒器械是一种常用的标准技术，也是治疗小儿脑瘫和神经肌肉型脊柱侧弯患者的主要器械系统，因为它使用简单，比大多数其他系统成本低得多，能实现良好的畸形矫正，矫正丢失率低，相关并发症发生率低，再次手术率也低。
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