Greggi T, Lolli F, Di Silvestre M, Martikos K, Vommaro F, Maredi E, Giacomini S, Baioni A, Cioni A
Department of Spinal Deformity Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy.
Stud Health Technol Inform. 2012;176:334-7.
Early onset scoliosis (EOS) surgery based on growing spinal implants can lead to several complications. Aim of the study was to identify strategies to prevent those complications. A retrospective review was conducted to identify all pediatric patients affected by EOS surgically treated with growing rod or Vertical Expandable Prosthetic Titanium Rib (VEPTR) at our division between 2006 and 2011. Nineteen consecutive patients (8 males, 11 females; mean age 6.8 years) were included. The scoliosis was: idiopathic in 7 cases, congenital in 5, associated with congenital heart disease in 2, with syringomyelia and Arnold Chiari syndrome in 1, with neurofibromatosis type 1 (NF1) in 1, with Prader Willi syndrome in 1, with trisomy 8 in 1, with arthrogryposis in 1. Instrumentation used was: growing rod in 9 patients (dual rod construct in 8 cases, single rod in 1), VEPTR in 10 (always rib to spine construct). At a mean follow-up of 28 months (range, 12 to 55) 12 mechanical complications occurred in 8 of 19 patients treated (42.1%). Among cases treated with growing rod (9) 6 complications occurred in 4 patients (44.4%): revision was performed in 4 cases due to proximal anchors migration, in 2 cases due to a rod breakage. Among cases treated with VEPTR (10) 6 complications occurred in 4 patients (40%): revision was performed in 4 cases due to rib fracture with anchors migration, in 1 case due to vertebral anchor migration and in 1 case due to proximal and distal anchor migration. So, in our series mechanical complications rate was 42.1%. Our strategy to prevent these complications is to use hooks as proximal anchors, to avoid single rod construct and to use a brace as external support until final surgery is performed. If it's possible, is better to substitute VEPTR with a dual Growing Rod implant when patient's age and anatomy permits this.
基于生长型脊柱植入物的早发性脊柱侧弯（EOS）手术可能会导致多种并发症。本研究的目的是确定预防这些并发症的策略。我们进行了一项回顾性研究，以确定2006年至2011年间在我们科室接受生长棒或垂直可扩张人工钛肋骨（VEPTR）手术治疗的所有受EOS影响的儿科患者。纳入了19例连续患者（8例男性，11例女性；平均年龄6.8岁）。脊柱侧弯情况如下：特发性7例，先天性5例，合并先天性心脏病2例，合并脊髓空洞症和阿诺德·奇亚里综合征1例，合并1型神经纤维瘤病（NF1）1例，合并普拉德-威利综合征1例，合并8三体综合征1例，合并关节挛缩症1例。使用的器械如下：9例患者使用生长棒（8例为双棒结构，1例为单棒），10例患者使用VEPTR（均为肋骨至脊柱结构）。平均随访28个月（范围12至55个月），19例接受治疗的患者中有8例（42.1%）出现了12例机械并发症。在使用生长棒治疗的病例（9例）中，4例患者出现了6例并发症（44.4%）：4例因近端锚钉移位进行了翻修，2例因棒体断裂进行了翻修。在使用VEPTR治疗的病例（10例）中，4例患者出现了6例并发症（40%）：4例因肋骨骨折伴锚钉移位进行了翻修，1例因椎体锚钉移位进行了翻修，1例因近端和远端锚钉移位进行了翻修。因此，在我们的系列研究中，机械并发症发生率为42.1%。我们预防这些并发症的策略是使用钩作为近端锚钉，避免单棒结构，并在最终手术前使用支具作为外部支撑。如果可能，在患者年龄和解剖结构允许的情况下，最好用双生长棒植入物替代VEPTR。
