Sistonen Saara J, Helenius Ilkka, Peltonen Jari, Sarna Seppo, Rintala Risto J, Pakarinen Mikko P
Section of Pediatric Surgery, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland.
Pediatrics. 2009 Dec;124(6):e1198-204. doi: 10.1542/peds.2008-3704. Epub 2009 Nov 9.
Clinical characteristics of spinal deformities that commonly occur in patients with esophageal atresia (EA) are unclear. The objective of this study was to assess the incidence and natural history of spinal anomalies and scoliosis in patients with EA.
A population-based cohort of 100 adults who had an operation for EA in our hospital were examined clinically and radiographically for spinal deformities. The results were compared with data obtained from normal population-based controls.
Vertebral anomalies were observed in 45 patients, predominating in the cervical spine in 38 patients. Any additional anomaly was the most significant risk factor (odds ratio [OR]: 27 [95% confidence interval (CI): 8-100]) for the occurrence of vertebral anomalies. Scoliosis of >10 degrees was observed in 56 patients, >20 degrees in 11 patients, and >45 degrees in 1 patient. The risk for scoliosis of >10 degrees was 13-fold (OR: 13 [95% CI: 8.3-21]), and the risk for scoliosis of >20 degrees was 38-fold (OR: 38 [95% CI: 14-106]) compared with those in the normal population. Thoracotomy-induced rib fusions (OR: 3.6 [95% CI: 0.7-19]) and other associated anomalies (OR: 2.1 [95% CI: 0.9-2.9]) were the strongest predictive factors for scoliosis. The general clinical course of spinal deformities was mild, and none of the patients had undergone spinal surgery.
The risk of scoliosis is 13-fold after repair of EA in relation to general population. Nearly half of the patients have vertebral anomalies predominating in the cervical spine. Most of these deformities were not diagnosed primarily or during growth. Spinal surgery is rarely indicated.
食管闭锁（EA）患者中常见的脊柱畸形的临床特征尚不清楚。本研究的目的是评估EA患者脊柱异常和脊柱侧凸的发生率及自然病史。
对我院100例接受EA手术的成年患者进行基于人群的队列研究，对其进行脊柱畸形的临床和影像学检查。将结果与从正常人群对照中获得的数据进行比较。
45例患者观察到椎体异常，其中38例以颈椎为主。任何其他异常是椎体异常发生的最显著危险因素（比值比[OR]：27[95%置信区间（CI）：8 - 100]）。56例患者观察到脊柱侧凸大于10度，11例大于20度，1例大于45度。与正常人群相比，大于10度脊柱侧凸的风险为13倍（OR：13[95%CI：8.3 - 21]），大于20度脊柱侧凸的风险为38倍（OR：38[95%CI：14 - 106]）。开胸手术引起的肋骨融合（OR：3.6[95%CI：0.7 - 19]）和其他相关异常（OR：2.1[95%CI：0.9 - 2.9]）是脊柱侧凸最强的预测因素。脊柱畸形的总体临床过程较轻，且没有患者接受过脊柱手术。
EA修复后脊柱侧凸的风险相对于普通人群为13倍。近一半的患者有以颈椎为主的椎体异常。这些畸形大多在初次时或生长过程中未被诊断出来。很少需要进行脊柱手术。
