Demirkiran Gokhan, Yilmaz Güney, Kaymaz Burak, Akel Ibrahim, Ayvaz Mehmet, Acaroglu Emre, Alanay Ahmet, Yazici Muharrem
*Hacettepe University Hospitals, Hacettepe University Medical School §Ankara Spine Center †Silvan Government Hospital, Diyarbakir ‡Kent Hospital, Izmir ∥Bilim University Hospital, University Medical School, Istanbul, Turkey.
J Pediatr Orthop. 2014 Apr-May;34(3):275-81. doi: 10.1097/BPO.0000000000000090.
Anterior and posterior convex hemiepiphysiodesis is a widely used surgical alternative in the treatment of congenital scoliosis. This procedure has the disadvantage of the need for both anterior and posterior approaches. Furthermore, outcomes may be unpredictable. Posterior convex growth arrest (CGA) with pedicle screws at each segment on the convex side may obviate the need for anterior surgery and provides more predictable outcomes. This study retrospectively evaluates the safety and efficacy of instrumented posterior CGA in congenital scoliosis.
Patients who had posterior CGA with convex pedicle screw instrumentation for congenital scoliosis were evaluated retrospectively. Thirteen patients (6 male, 7 female) were included in the study. Preoperative, early postoperative, and last follow-up standing posteroanterior and lateral x-rays were evaluated. Cobb angles were recorded for the instrumented segment (main curve). Global thoracic kyphosis was measured between T2 and T12 on sagittal plane. These values were compared preoperatively, postoperatively, and at last follow-up. The T1-S1 vertical height and the height between the concave side pedicles of the upper and lower end vertebra of the main curve was also determined and recorded as the concave height.
The average follow-up was 56.1±10 months (range, 36 to 74 mo) and the average age of the patients at the time of operation was 64.5±30.1 months (range, 15 to 108 mo). All patients were Risser zero at the time of surgery. The average curve magnitude was 49±10.9 degrees (range, 34 to 68 degrees) preoperatively, 38.3±9.7 degrees (range, 28 to 58 degrees) early postoperatively, and 33.5±12.4 degrees (16 to 52 degrees) at last follow-up. There was a significant difference between the preoperative and early postoperative main curve Cobb angle measurements (P=0.001). The average concave height was 94.2±20.2 mm in the early postoperative period and 104.7±21.7 mm at last follow-up (P=0.003). The average T1-S1 height was 292.1±67.1 mm in the early postoperative period and 363.9±94.5 mm at last follow-up (P=0.005). There was at least ≥5 degrees improvement in 9 of the 12 patients in the follow-up period after the index procedure. In 3 patients, the curve did not change and the correction was maintained. Curve progression was observed in 1 patient due to a technical error. There were no wound infections or instrumentation failures during follow-up.
Instrumented CGA can safely be used in long sweeping curves of immature spines. Using this technique; thoracotomy, anterior procedure, and 2-stage surgery can be avoided. Moreover, it guarantees some degree of correction in all patients because of the instrumentation effect, eliminating the unpredictable nature of classic CGA.
Therapeutic level IV study.
前后凸半椎体骨骺阻滞术是治疗先天性脊柱侧凸广泛应用的手术方式。该手术的缺点是需要前后路联合手术。此外，治疗效果可能不可预测。在凸侧每个节段使用椎弓根螺钉进行后路凸侧生长阻滞（CGA）可避免前路手术的需要，并提供更可预测的治疗效果。本研究回顾性评估先天性脊柱侧凸后路器械辅助CGA的安全性和有效性。
对接受后路CGA联合凸侧椎弓根螺钉内固定治疗先天性脊柱侧凸的患者进行回顾性评估。13例患者（6例男性，7例女性）纳入本研究。评估术前、术后早期及末次随访时的站立位正侧位X线片。记录内固定节段（主弯）的Cobb角。在矢状面上测量T2和T12之间的全胸段后凸角。对这些数值在术前、术后及末次随访时进行比较。还测定并记录T1-S1垂直高度以及主弯上下端椎凹侧椎弓根之间的高度作为凹侧高度。
平均随访时间为56.1±10个月（范围36至74个月），患者手术时的平均年龄为64.5±30.1个月（范围15至108个月）。所有患者手术时Risser征均为0级。术前平均侧弯角度为49±10.9度（范围34至68度），术后早期为38.3±9.7度（范围28至58度），末次随访时为33.5±12.4度（16至52度）。术前与术后早期主弯Cobb角测量值之间有显著差异（P = 0.001）。术后早期平均凹侧高度为94.2±20.2 mm，末次随访时为104.7±21.7 mm（P = 0.003）。术后早期平均T1-S1高度为292.1±67.1 mm，末次随访时为363.9±94.5 mm（P = 0.005）。在初次手术后的随访期内，12例患者中有9例至少改善了≥5度。3例患者侧弯未改变且矫正得以维持。1例患者因技术失误出现侧弯进展。随访期间无伤口感染或内固定失败。
器械辅助CGA可安全用于未成熟脊柱的长节段侧弯。采用该技术可避免开胸手术、前路手术及二期手术。此外，由于内固定作用，可保证所有患者获得一定程度的矫正，消除了经典CGA的不可预测性。
治疗性IV级研究。
