Ahmad Alaaeldin A
Department of Orthopedic, Annajah Medical School, Nablus, Palestine.
J Pediatr Orthop B. 2013 Nov;22(6):595-601. doi: 10.1097/BPB.0b013e3283633150.
Surgery for myelomeningocele spinal deformity is accompanied by a high rate of complications. These include infection, pathological skin breakage, instrumentation failure, and neurological deterioration. The four-rib construct associated with the percutaneous technique in immature children with myelomeningocele and spinal deformity is introduced. The four-rib construct serves to correct for deformity and to allow for growth, with minimal complications. The study was small and retrospective, a level four case series. The results of four patients who underwent the four-rib construct surgery in 2008 and 2009 was revised. All four were nonambulatory, skeletally immature children, not previously corrected by bracing, with the progressive spinal deformity associated with myelomeningocele affecting their sitting position. Furthermore, the research protocol was approved by our institutional review board. Three patients were females and one was male. Two cases of kyphoscoliosis, one of kyphosis, and one of scoliosis. Age at the time of the initial procedure ranged between 64 and 82 months, with a mean age of 70 months. Follow-up time after surgery ranged from 24 to 39 months, with a mean of 31 months. Preoperatively, deformity angles were severe, averaging 55° for thoracic scoliosis, 67° for thoracolumbar scoliosis, and 85° for thoracolumbar kyphosis. Surgery mitigated the deformities markedly. Postoperative angles measured were 42° for thoracic scoliosis, 21° for thoracolumbar scoliosis, and 45° for thoracolumbar kyphosis. These observations indicate significant reductions in spinal deformity, by 24, 69, and 48%, respectively. In total, 14 procedures were performed: four initial implants and 10 lengthening and exchange procedures. There were no intraoperative complications. The postoperative complications that did arise consisted of two instances of skin breakage, one distal iliac screw dislodgement, and one shunt displacement. Significantly, no proximal fixation dislodgement, deep-seated infection, or damage in the pathological skin were detected. The four-rib construct technique can be considered as a potential surgical option in (powered by Editorial Manager and Preprint Manager; Aries Systems Corporation) treating spinal deformity associated with myelomeningocele, but still more patients with long term follow-up are needed to prove the efficacy of this procedure. The four-rib construct is simple, minimally invasive, and does not exclude alternative treatment. Moreover, the incidence of complications associated with the four-rib construct compares favorably with other growth techniques.
脊髓脊膜膨出脊柱畸形手术伴随着较高的并发症发生率。这些并发症包括感染、病理性皮肤破损、器械故障和神经功能恶化。本文介绍了针对患有脊髓脊膜膨出和脊柱畸形的未成熟儿童的经皮技术相关的四肋结构。四肋结构用于矫正畸形并允许生长，并发症最少。该研究规模较小且为回顾性研究，属于四级病例系列。对2008年和2009年接受四肋结构手术的4例患者的结果进行了修订。所有4例均为非行走型、骨骼未成熟儿童，此前未通过支具矫正，患有与脊髓脊膜膨出相关的进行性脊柱畸形，影响其坐姿。此外，研究方案已获我们机构审查委员会批准。3例为女性，1例为男性。2例为脊柱侧凸，1例为后凸，1例为脊柱侧凸。初次手术时的年龄在64至82个月之间，平均年龄为70个月。术后随访时间为24至39个月，平均为31个月。术前，畸形角度严重，胸椎侧凸平均为55°，胸腰段侧凸为67°，胸腰段后凸为85°。手术显著减轻了畸形。术后测量的角度为：胸椎侧凸42°，胸腰段侧凸21°，胸腰段后凸45°。这些观察结果表明脊柱畸形分别显著降低了24%、69%和48%。总共进行了14次手术：4次初次植入和10次延长及置换手术。术中无并发症。术后出现的并发症包括2例皮肤破损、1例远端髂骨螺钉移位和1例分流管移位。值得注意的是，未检测到近端固定移位、深部感染或病理性皮肤损伤。四肋结构技术可被视为治疗与脊髓脊膜膨出相关的脊柱畸形的一种潜在手术选择（由编辑管理器和预印本管理器提供支持；Aries Systems Corporation），但仍需要更多患者进行长期随访以证明该手术的疗效。四肋结构简单、微创，且不排除其他治疗方法。此外，与四肋结构相关的并发症发生率与其他生长技术相比具有优势。
