Department of Orthopaedics and Traumatology, Bilim University Faculty of Medicine, Istanbul Spine Center at Florence Nightingale Hospital, Abide-i Hurriyet cad No: 290, ŞİŞLİ, Istanbul, Turkey.
Clin Orthop Relat Res. 2012 Apr;470(4):1144-50. doi: 10.1007/s11999-011-1878-y. Epub 2011 Apr 12.
The convex growth arrest (CGA) procedure has been well accepted for treatment of congenital scoliosis as it is a simpler procedure with successful results. However, unpredictability of curve behavior, slow and usually inadequate correction, and necessity of anterior surgery for completeness of the epiphysiodesis are its shortcomings.
QUESTIONS/PURPOSES: In a preliminary study we asked whether a modification of the CGA procedure using convex instrumented hemiepiphysiodesis with concave distraction would correct the coronal plane Cobb angles and would correct or maintain sagittal plane local and global kyphosis angles. We also identified complications.
We retrospectively reviewed five female patients who underwent the modified procedure. Their mean age at the index operation was 40 months (range, 17-55 months). The patients underwent concave distractions every 6 months. The magnitude of the convex instrumented and concave distracted curves and sagittal plane parameters were determined on the preoperative and most recent followup radiographs. Minimum followup was 26 months (mean, 34 months; range, 26-40 months).
In the coronal plane, the preoperative magnitude of the convex instrumented congenital curve averaged 48°. It was corrected to 36° (25%) postoperatively and was further improved to 27° (44%) at the latest followup. For the distracted segment, the mean preoperative curve was 35°, corrected to 16° postoperatively and to 8° at the latest followup, for an average correction of 77%. Sagittal plane alignment was minimally affected from the procedure. In four of the five patients we identified partial pullout of screws for the concave distraction; these were revised at the time of planned lengthening.
This procedure may obviate the need for multiple osteotomies and long thoracic fusions in young children with long sweeping thoracic deformities involving multiple anomalous vertebrae. Implant-related complications on the concave side may be avoided using paired pedicle screws at the proximal and distal anchor sites.
Level IV, therapeutic study. See the guidelines online for a complete description of level of evidence.
凸侧生长阻滞（CGA）术式已被广泛用于治疗先天性脊柱侧凸，因为它是一种更简单的手术，且效果良好。然而，其存在曲线预测性差、矫正缓慢且通常不足、以及为了完成骺板融合需要行前路手术等缺点。
问题/目的：在一项初步研究中，我们询问了一种改良的 CGA 术式，即凸侧经皮骺板螺钉固定联合凹侧撑开是否可以矫正冠状面 Cobb 角，并矫正或维持矢状面局部和整体后凸角。我们还确定了并发症。
我们回顾性分析了 5 例女性患者，这些患者均接受了改良术式。患者的初次手术时的平均年龄为 40 个月（范围，17-55 个月）。患者每隔 6 个月进行一次凹侧撑开。根据术前和末次随访的 X 线片，确定凸侧经皮骺板螺钉固定和凹侧撑开的曲线大小以及矢状面参数。随访时间至少为 26 个月（平均 34 个月；范围，26-40 个月）。
在冠状面，术前凸侧先天性脊柱侧凸的平均角度为 48°。术后矫正至 36°（25%），末次随访时进一步改善至 27°（44%）。对于撑开节段，术前平均曲线为 35°，术后矫正至 16°，末次随访时矫正至 8°，平均矫正率为 77%。矢状面的排列基本不受手术影响。在 5 例患者中有 4 例发现凹侧螺钉部分拔出，在计划延长时进行了修正。
对于存在多个异常椎体的长节段胸腰段畸形的幼儿，该术式可能避免了多次截骨和长节段胸椎融合。通过在近端和远端锚定点使用配对的椎弓根螺钉，可以避免凹侧与植入物相关的并发症。
IV 级，治疗性研究。有关证据水平的完整描述，请参见在线指南。
