Children's Hospital Los Angeles, Los Angeles, CA 90027, USA.
Spine (Phila Pa 1976). 2009 Nov 1;34(23):2530-3. doi: 10.1097/BRS.0b013e3181bd09f5.
Retrospective review of patients from a multicenter database.
To evaluate the nutritional status of children with thoracic insufficiency syndrome (TIS) and to determine if treatment with vertical expandable prosthetic titanium ribs (VEPTR) leads to improvements in weight percentile.
Children with pulmonary insufficiency characteristically have poor nutrition as the energy expenditure from the extra work of breathing approaches the nutritional gain of eating. To our knowledge, no previous studies have examined the relation between VEPTR and potential nutritional improvements in children with TIS.
Seventy-six patients at 7 different institutions underwent placement of VEPTR devices for treatment or prevention of TIS. Mean age at surgery was 3.7 years (range, 8 months-14 years). All patients were observed for a minimum of 24 months with an average follow-up of 3.3 years (range, 2-6 years). Before surgery and at each postoperative visit, patients were weighed and the Cobb angle was measured. All weights were converted to normative percentiles based on the patient's age.
Overall, we found a significant increase in the percentile of patients' weights after VEPTR surgery (P = 0.0004). Of the 76 patients in our series, 60 (79%) were < or =5 percentile in weight before surgery. Of these most nutritionally depleted patients, 40% (24/60) had increase in percentile weight after surgery; more subjects may have improved, but due to the basement effect < or =5 percentile any improvement in which the final weight was under 5 percentile may not have been detected. Of the 16 patients who were >5 percentile weight before surgery, 50% (8/16) had increased weight percentiles after surgery. For most patients, the majority of weight gain occurred between 4 and 8 months after surgery; weight gain continued up to 48 months after surgery. The change in Cobb angle had no relation to the change in weight percentile.
A total of 79% of patients with TIS were less than 5 percentile in weight, thus meeting the criteria for "failure to thrive." Our study demonstrates a significant improvement in the nutritional status of these children after VEPTR surgery, which is an important outcome measure in this population.
对多中心数据库中的患者进行回顾性研究。
评估胸廓发育不良综合征（TIS）患儿的营养状况，并确定垂直扩张性假体钛肋骨（VEPTR）治疗是否可导致体重百分位升高。
有肺功能不全特征的儿童通常营养状况较差，因为额外呼吸做功的能量消耗接近进食的营养增益。据我们所知，以前没有研究检查过 VEPTR 与 TIS 患儿潜在营养改善之间的关系。
7 家不同机构的 76 例患者接受 VEPTR 装置治疗或预防 TIS。手术时的平均年龄为 3.7 岁（范围：8 个月至 14 岁）。所有患者均接受了至少 24 个月的观察，平均随访时间为 3.3 年（范围：2-6 年）。在手术前和每次术后就诊时，患者都进行了称重和 Cobb 角测量。所有体重均根据患者的年龄转换为标准百分位数。
总体而言，我们发现 VEPTR 手术后患者体重的百分位数显著增加（P = 0.0004）。在我们的系列研究中，76 例患者中有 60 例（79％）体重在手术前处于<或=5 百分位。在这些营养状况最差的患者中，40％（24/60）术后体重百分位增加；可能有更多患者改善，但由于基础效应<或=5 百分位，最终体重低于 5 百分位的任何改善都可能未被发现。在手术前体重处于>5 百分位的 16 例患者中，50％（8/16）术后体重百分位增加。对于大多数患者，大多数体重增加发生在手术后 4 至 8 个月之间；手术后 48 个月仍继续增加体重。Cobb 角的变化与体重百分位的变化无关。
79％的 TIS 患者体重低于 5 百分位，因此符合“生长不良”的标准。我们的研究表明，VEPTR 手术后这些儿童的营养状况有显著改善，这是该人群的一个重要结果衡量标准。
