Orthopaedic Department, University Children's Hospital, Roemergasse 8, 4005 Basel, Switzerland.
Eur Spine J. 2010 Mar;19(3):400-8. doi: 10.1007/s00586-009-1253-9. Epub 2009 Dec 31.
This retrospective study analyses 23 children treated with vertical expandable prosthetic titanium rib (VEPTR) for correction of non-congenital early onset spine deformities. After the index procedure (IP), the device was lengthened at 6-month intervals. The average (av) age at the time of IP was 6.5 years (1.11-10.5). The av follow-up time was 3.6 years (2-5.8). Diagnosis included 1 early onset idiopathic scoliosis, 11 neuromuscular, 2 post-thoracotomy scoliosis, 1 Sprengel deformity, 2 hyperkyphosis, 1 myopathy and 5 syndromic. Surgeries (187) included 23 IPs, av 6.5 (4-10) device expansions per patient (149) and 15 unplanned surgeries. 23 complications (0.13 per surgery) included 10 skin sloughs, 5 implant dislocations, 2 rod breakages and 6 infections. Coronal Cobb angle was av 68 degrees (11 degrees -111 degrees ), at follow-up av 54 degrees (0 degrees -105 degrees). Pelvic obliquity was av 33 degrees (13 degrees -60 degrees ), at follow-up av 16 degrees (0 degrees -42 degrees ). T1 tilt was av 29 degrees (5 degrees -84 degrees ), two remained unchanged, the remainder improved 10 degrees -68 degrees. Sagittal plane: All but two had stable profiles, two hyperkyphosis of 110 degrees /124 degrees improved to 56 degrees /86 degrees. Space available for lung ratio was less than 90% in ten before the IP, improved in nine and deteriorated in one. Originally designed for thoracic insufficiency syndromes related to rib and vertebral anomalies, VEPTR proved to be a valuable alternative to dual growing rods for non-congenital early onset spine deformities. The complication rate was lower, the control of the sagittal plane and the pelvic obliquity was as good, but the correction of the coronal plane deformity was less than growing rods. However, VEPTR's spine-sparing approach might provoke less spontaneous spinal fusion and ease the final correction at maturity.
本回顾性研究分析了 23 例因非先天性早发性脊柱畸形接受垂直可扩展假体钛肋骨（VEPTR）治疗的儿童。在索引手术（IP）后，每隔 6 个月延长一次设备。IP 时的平均（av）年龄为 6.5 岁（1.11-10.5）。平均随访时间为 3.6 年（2-5.8）。诊断包括 1 例早发性特发性脊柱侧凸、11 例神经肌肉疾病、2 例开胸术后脊柱侧凸、1 例 Sprengel 畸形、2 例脊柱后凸、1 例肌病和 5 例综合征。手术（187 例）包括 23 例 IP，平均每个患者进行 6.5 次（4-10）设备扩展，15 例计划外手术。23 例并发症（每例手术 0.13 例）包括 10 例皮肤坏死、5 例植入物脱位、2 例棒断裂和 6 例感染。冠状 Cobb 角平均为 68 度（11-111 度），随访时平均为 54 度（0-105 度）。骨盆倾斜度平均为 33 度（13-60 度），随访时平均为 16 度（0-42 度）。T1 倾斜度平均为 29 度（5-84 度），2 度不变，其余改善 10-68 度。矢状面：除 2 例外，所有患者的脊柱侧凸均稳定，2 例 110/124 度的脊柱后凸改善至 56/86 度。IP 前 10 例肺容积比小于 90%，9 例改善，1 例恶化。VEPTR 最初设计用于与肋骨和椎体异常相关的胸段发育不良综合征，现已成为非先天性早发性脊柱畸形的双生长棒的有效替代方法。并发症发生率较低，矢状面和骨盆倾斜度的控制与生长棒相同，但冠状面畸形的矫正效果不如生长棒。然而，VEPTR 的脊柱保留方法可能会引起较少的自发性脊柱融合，并在成熟时更容易进行最终矫正。
