Baca Kirsten E, Abdullah Madeel A, Ting Beverlie L, Schkrohowsky Joshua G, Hoernschemeyer Daniel G, Carson Benjamin S, Ain Michael C
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
J Pediatr Orthop. 2010 Jul-Aug;30(5):449-54. doi: 10.1097/BPO.0b013e3181e00c66.
Spinal stenosis is a common complication of achondroplasia. To our knowledge, no study has evaluated a greater than 2-year outcome after surgical intervention for spinal stenosis in such children or compared decompression with and without instrumentation in relation to revision surgery. Our purpose was to assess the efficacy of lumbar decompression and instrumentation for symptomatic stenosis in children with achondroplasia.
We retrospectively reviewed our institution's database to identify children (< or =18 y old) with achondroplasia undergoing initial spinal decompression for lumbar stenosis from 1995 through 2003. We identified 18 such patients and reviewed their medical records for demographic data, presenting signs and symptoms, and treatment and outcome data. Mean follow-up was 72.0+/-27.6 months. We determined each patient's symptom score (SS) based on presence of leg weakness, numbness, or pain; abnormal reflexes; incontinence; and walking intolerance (unable to walk > or =5 blocks). Each finding was scored 1 point (6 points maximum). Nine patients requiring revision surgery were assigned a revision postoperative SS. All patients were contacted at the end of data collection and assigned a final follow-up SS. Baseline SS values were compared with postoperative, revision postoperative, and final follow-up scores using a paired t test (alpha=0.05).
The mean preoperative and final SS values were significantly different: 4.0+/-0.9 (most common symptoms, leg weakness and incontinence) and 1.6+/-1.7 (most common symptom, leg weakness), respectively. Nine patients underwent decompression with instrumentation initially; 9 did not; 7 of the latter required instrumentation during revision; and 2 of the former also required revision. Those without initial instrumentation were 3.5 times more likely (odds ratio=12.3) to require revision.
Surgical decompression with instrumentation significantly reduced the symptoms of lumbar stenosis and the likelihood of revision surgery in children with achondroplasia.
Level III therapeutic study.
椎管狭窄是软骨发育不全的常见并发症。据我们所知，尚无研究评估此类儿童接受脊柱狭窄手术干预超过2年的结果，也未比较有无内固定的减压术与翻修手术的关系。我们的目的是评估腰椎减压及内固定治疗软骨发育不全患儿症状性狭窄的疗效。
我们回顾性分析了本机构数据库，以确定1995年至2003年期间因腰椎狭窄接受初次脊柱减压的软骨发育不全患儿（年龄≤18岁）。我们确定了18例此类患者，并查阅他们的病历以获取人口统计学数据、呈现的体征和症状以及治疗和结果数据。平均随访时间为72.0±27.6个月。我们根据腿部无力、麻木或疼痛、异常反射、大小便失禁以及行走不耐受（无法行走≥5个街区）的情况确定每位患者的症状评分（SS）。每项表现评分为1分（最高6分）。9例需要翻修手术的患者被给予翻修术后SS评分。在数据收集结束时联系所有患者，并给予最终随访SS评分。使用配对t检验（α=0.05）将基线SS值与术后、翻修术后及最终随访评分进行比较。
术前和最终SS值存在显著差异：分别为4.0±0.9（最常见症状为腿部无力和大小便失禁）和1.6±1.7（最常见症状为腿部无力）。9例患者最初接受了带内固定的减压术；9例未接受；后者中有7例在翻修时需要内固定；前者中有2例也需要翻修。未进行初次内固定的患者需要翻修的可能性高3.5倍（比值比=12.3）。
带内固定的手术减压显著减轻了软骨发育不全患儿腰椎狭窄的症状及翻修手术的可能性。
III级治疗性研究。
