*Department of Pediatric Orthopaedic Surgery, Hôpital Sud, Rennes, France †Department of Pediatric Orthopaedic Surgery, Hôpital La Timone, Marseille, France ‡Department of Pediatric Orthopaedic Surgery, Hôpital Purpan Enfants, Toulouse, France §Department of Pediatric Orthopaedic Surgery, Hôpital d'enfants, Vandoeuvre lès Nancy, France ¶Department of Pediatric Orthopaedic Surgery, Hôpital Hautepierre, Strasbourg, Germany ‖Department of Pediatric Orthopaedic Surgery, CHU de Caen, Caen, France **Department of Pediatric Orthopaedic Surgery, Hôpital Morvan, Brest, France ††Department of Pediatric Orthopaedic Surgery, CHU de Montpellier, Montpellier, France ‡‡Department of Pediatric Orthopaedic Surgery, CHU de Besançon, Besançon, France; and §§Department of Pediatric Orthopaedic Surgery, CHU de Lille, Lille, France.
Spine (Phila Pa 1976). 2013 Dec 1;38(25):E1589-99. doi: 10.1097/BRS.0000000000000014.
Multicenter retrospective study of 54 children.
To describe the complication rate of the French vertical expandable prosthetic titanium rib (VEPTR) series involving patients treated between August 2005 and January 2012.
Congenital chest wall and spine deformities in children are complex entities. Most of the affected patients have severe scoliosis often associated with a thoracic deformity. Orthopedic treatment is generally ineffective, and surgical treatment is very challenging. These patients are good candidates for VEPTR expansion thoracoplasty. The aim of this study was to evaluate the potential complications of VEPTR surgery.
Of the 58 case files, 54 were available for analysis. The series involved 33 girls and 21 boys with a mean age of 7 years (range, 20 mo-14 yr and 2 mo) at primary VEPTR surgery. During the follow-up period, several complications occurred.
Mean follow-up was 22.5 months (range, 6-64 mo). In total, 184 procedures were performed, including 56 VEPTR implantations, 98 expansions, and 30 nonscheduled procedures for different types of complications: mechanical complications (i.e., fracture, device migration), device-related and infectious complications, neurological disorders, spine statics disturbances. Altogether, there were 74 complications in 54 patients: a complication rate of 137% per patient and 40% per surgery. Comparison of the complications in this series with those reported in the literature led the authors to suggest solutions that should help decrease their incidence.
The complication rate is consistent with that reported in the literature. Correct determination of the levels to be instrumented, preoperative improvement of nutritional status, and better evaluation of the preoperative and postoperative respiratory function are important factors in minimizing the potential complications of a technique that is used in weak patients with complex deformities.
对 54 名儿童进行的多中心回顾性研究。
描述 2005 年 8 月至 2012 年 1 月期间接受治疗的患者使用法国垂直可扩张假体钛肋骨（VEPTR）系列的并发症发生率。
儿童先天性胸壁和脊柱畸形是复杂的实体。大多数受影响的患者都有严重的脊柱侧凸，通常伴有胸廓畸形。矫形治疗通常无效，手术治疗极具挑战性。这些患者是 VEPTR 扩张胸廓成形术的良好候选者。本研究旨在评估 VEPTR 手术的潜在并发症。
在 58 份病例中，有 54 份可用于分析。该系列包括 33 名女孩和 21 名男孩，初次 VEPTR 手术时的平均年龄为 7 岁（范围，20 个月至 14 岁和 2 个月）。在随访期间，发生了多种并发症。
平均随访时间为 22.5 个月（范围，6-64 个月）。总共进行了 184 次手术，包括 56 次 VEPTR 植入术、98 次扩张术和 30 次非计划手术，用于治疗各种类型的并发症：机械并发症（即骨折、器械迁移）、器械相关和感染性并发症、神经障碍、脊柱静力学紊乱。总共 54 名患者中有 74 名发生并发症：每名患者的并发症发生率为 137%，每例手术的并发症发生率为 40%。将本系列中的并发症与文献中的报道进行比较，促使作者提出了一些解决方案，这有助于降低该技术的发生率。
并发症发生率与文献报道的一致。正确确定需要器械固定的水平、术前改善营养状况、更好地评估术前和术后呼吸功能，是最大限度减少在患有复杂畸形的虚弱患者中使用该技术的潜在并发症的重要因素。
