骨骼发育不良中保留生长的脊柱内固定术。
Growth-sparing spinal instrumentation in skeletal dysplasia.
作者信息
Karatas Ali F, Dede Ozgur, Rogers Kenneth, Ditro Colleen P, Holmes Laurens, Bober Michael, Shah Suken A, Mackenzie William G
机构信息
From the Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
出版信息
Spine (Phila Pa 1976). 2013 Nov 15;38(24):E1517-26. doi: 10.1097/BRS.0b013e3182a590f0.
STUDY DESIGN
Retrospective case series.
OBJECTIVE
To report the outcomes of distraction-based, growth-sparing spinal instrumentation in patients with skeletal dysplasia.
SUMMARY OF BACKGROUND DATA
Patients with skeletal dysplasia with spinal deformity often undergo early fusion, further compromising an already small chest. Nonfusion techniques may provide a safe alternative and allow for thoracic growth.
METHODS
Between 2004 and 2010, 12 children with a diagnosis of various types of skeletal dysplasia underwent growth-sparing spinal instrumentation for severe spinal deformities. The mean duration of treatment with growing rods was 57 months (42-84 mo). Nine patients were treated with growing rods (8 dual, 1 single), and 3 were treated with vertical expandable prosthetic titanium rib (VEPTR; Synthes). Preoperative, initial postoperative, and final follow-up anteroposterior and lateral spine radiographs were measured for magnitude of deformity, junctional kyphosis, and implant failure.
RESULTS
The major curve Cobb angle improved from a mean of 79° preoperatively to a mean of 41° at the last follow-up (52%). There was a decrease in mean thoracic kyphosis from 77° preoperatively to 64° at final follow-up and an increase in mean lumbar lordosis from 58° preoperatively to 63° at final follow-up. The mean space available for the lungs increased by 26 mm on the concave and 24 mm on the convex side. Six patients required revision surgery for proximal junctional kyphosis. There were 4 rod failures and 6 hook and 8 screw dislodgements. One patient with vertical expandable prosthetic titanium rib had failed rib fixation that required revision.
CONCLUSION
Growth-sparing spinal instrumentation in patients with skeletal dysplasia and severe spinal deformity has a high complication and revision rate, and surgeons should closely monitor these patients. The complication rate is comparable with previous reports on patients with other diagnoses. However, deformities were well controlled, some trunk growth was achieved, and fusion surgery was delayed in all cases.
LEVEL OF EVIDENCE
研究设计
回顾性病例系列研究。
目的
报告基于撑开技术的保留生长的脊柱内固定术治疗骨骼发育不良患者的结果。
背景资料总结
患有脊柱畸形的骨骼发育不良患者常需早期融合手术，这会进一步损害本就狭小的胸廓。非融合技术可能提供一种安全的替代方法，并允许胸廓生长。
方法
2004年至2010年间，12例诊断为各种类型骨骼发育不良的儿童因严重脊柱畸形接受了保留生长的脊柱内固定术。生长棒治疗的平均持续时间为57个月（42 - 84个月）。9例患者接受生长棒治疗（8例双棒，1例单棒），3例患者接受垂直可扩张人工钛肋（VEPTR；辛迪斯公司）治疗。测量术前、术后初期及末次随访时脊柱正侧位X线片上的畸形程度、交界性后凸及植入物失败情况。
结果
主弯Cobb角从术前平均79°改善至末次随访时的平均41°（改善52%）。胸段后凸平均角度从术前的77°降至末次随访时的64°，腰段前凸平均角度从术前的58°增至末次随访时的63°。肺脏的平均可用空间在凹侧增加了26 mm，凸侧增加了24 mm。6例患者因近端交界性后凸需要翻修手术。有4例棒体断裂，6例钩及8例螺钉移位。1例接受垂直可扩张人工钛肋治疗的患者出现肋骨固定失败，需要翻修。
结论
骨骼发育不良及严重脊柱畸形患者采用保留生长的脊柱内固定术并发症及翻修率较高，外科医生应密切监测这些患者。并发症发生率与先前其他诊断患者的报道相当。然而，畸形得到了良好控制，在所有病例中均实现了一定程度的躯干生长，且融合手术得以延迟。
证据级别
4级。
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