Sponseller Paul D, Betz Randal, Newton Peter O, Lenke Lawrence G, Lowe Tom, Crawford Alvin, Sucato Daniel, Lonner Barry, Marks Michelle, Bastrom Tracey
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Spine (Phila Pa 1976). 2009 Apr 15;34(8):827-31. doi: 10.1097/BRS.0b013e31819139ef.
Retrospective review.
To compare the results of spinal fusion in patients with open triradiate cartilages (OTRC) and closed triradiate cartilages (CTRC).
Patients with OTRC at the time of spinal fusion may be at increased risk of developing postoperative changes related to growth.
From a database of patients with adolescent idiopathic scoliosis, we identified 44 patients with OTRC (mean age, 11.6 years) and 450 patients with CTRC (mean age, 15.6 years) and a minimum follow-up of 2 years. Patients in both groups were treated with anterior-only, posterior-only, or combined anterior and posterior spinal fusion; none had all-pedicle screw posterior instrumentation.
In the OTRC group, anterior or posterior instrumentation, but not the combined approach, resulted in a significant mean late increase in the main curve (4.4 degrees and 7.3 degrees vs. 0 degrees , respectively; P = 0.002), an approach-related difference not seen in the CTRC group. Significantly more OTRC patients had proximal levels added on after surgery than did CTRC patients (18% vs. 8%, respectively; P = 0.02), and there was a trend toward this phenomenon distally (29% vs. 19%, respectively; P = 0.10). Proximal and distal junctional kyphosis was not significantly different between the 2 groups. Reoperation rate was 11% and 7% for OTRC and CTRC patients, respectively. For the selectively fused Lenke 1C curves in OTRC and CTRC patients, there was a trend in the uninstrumented lumbar curve toward a smaller lumbar curve before surgery (36 degrees and 41 degrees , respectively; P = 0.07) and a larger curve after surgery (27 degrees and 24 degrees , respectively; P = 0.07).
Patients with scoliosis and OTRC have a greater risk of adding-on proximally and of loss of correction with anterior-only instrumentation; they may also have less predictable lumbar correction from selective thoracic fusion. However, after combined surgery, they have results similar to those of more skeletally mature patients.
回顾性研究。
比较开放性三放射状软骨（OTRC）和闭合性三放射状软骨（CTRC）患者脊柱融合的结果。
脊柱融合时患有OTRC的患者发生与生长相关的术后改变的风险可能增加。
从青少年特发性脊柱侧凸患者数据库中，我们确定了44例OTRC患者（平均年龄11.6岁）和450例CTRC患者（平均年龄15.6岁），且随访时间至少2年。两组患者均接受单纯前路、单纯后路或前后路联合脊柱融合治疗；均未采用全椎弓根螺钉后路内固定。
在OTRC组中，前路或后路内固定，但不是联合手术方式，导致主弯平均后期显著增加（分别为4.4度和7.3度，而联合手术方式为0度；P = 0.002），CTRC组未观察到这种与手术方式相关的差异。与CTRC患者相比，显著更多的OTRC患者术后增加了近端节段（分别为18%和8%；P = 0.02），并且在远端有这种现象的趋势（分别为29%和19%；P = 0.10）。两组近端和远端交界性后凸无显著差异。OTRC和CTRC患者的再次手术率分别为11%和7%。对于OTRC和CTRC患者中选择性融合的Lenke 1C曲线，未融合的腰椎曲线在术前有向较小腰椎曲线发展的趋势（分别为36度和41度；P = 0.07），术后有向较大曲线发展的趋势（分别为27度和24度；P = 0.07）。
脊柱侧凸和OTRC患者近端增加节段及单纯前路内固定矫正丢失的风险更大；他们选择性胸椎融合后的腰椎矫正也可能更难预测。然而，联合手术后，他们的结果与骨骼更成熟的患者相似。
