一期后路截骨短节段融合及双生长棒技术治疗重度僵硬型先天性脊柱侧凸：一种混合技术的初步临床疗效
One-stage posterior osteotomy with short segmental fusion and dual growing rod technique for severe rigid congenital scoliosis: the preliminary clinical outcomes of a hybrid technique.
作者信息
Wang Shengru, Zhang Jianguo, Qiu Guixing, Wang Yipeng, Weng Xisheng, Guo Jianwei
机构信息
From the Department of Orthopedics, Peking Union Medical College Hospital, Shuai Fu Yuan, Beijing, P. R. China.
出版信息
Spine (Phila Pa 1976). 2014 Feb 15;39(4):E294-9. doi: 10.1097/BRS.0000000000000119.
STUDY DESIGN
Retrospective study.
OBJECTIVE
To evaluate the clinical outcomes of the hybrid technique of 1-stage posterior osteotomy with short segmental fusion and dual growing rod (GR) technique for severe rigid congenital scoliosis.
SUMMARY OF BACKGROUND DATA
As some types of congenital scoliosis consist of long curve including sharp deformities producing enormous asymmetric growth at apex, they cannot be well corrected with osteotomy and short segmental fusion. GR technique may be the best option. However, enormous asymmetric growth potential due to the sharp deformities at the apex will increase risk of complications, especially implant failures.
METHODS
Seven patients (2 males, 5 females) undergoing this hybrid technique for severe rigid congenital scoliosis were retrospectively reviewed. The patients' charts were reviewed. The analysis included age at initial surgery and the latest follow-up, number and frequency of lengthening, and complications. Radiographical evaluation included measured changes in scoliosis Cobb angle, thoracic kyphosis, lumbar lordosis, trunk shift, length of T1-S1, and instrumentation.
RESULTS
The mean follow-up was 53.3 (30-77) months. The mean age at the initial surgery is 5.9 (2-10) years. The averaged lengthenings were of 5.3 per patient. The mean scoliosis improved from 81.4° to 40.1° after initial surgery and was 41.0° at the latest follow-up. The average T1-S1 length was of 1.23 cm per year. The space available for lung ratio increased from 0.86 to 0.96.
CONCLUSION
Osteotomy with short fusion could help to improve the correction of the GR and eliminate the large asymmetric growth potential around the apex, with little influence to the length of the spine. Dual GR technique could maintain correction achieved at initial surgery while allowing spinal growth to continue. This hybrid technique may be an option for young patients who present sharp deformities with large asymmetric growth potential in a long congenital spinal deformity.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
评估一期后路截骨短节段融合与双生长棒（GR）技术治疗严重僵硬型先天性脊柱侧凸的临床疗效。
背景资料总结
由于某些类型的先天性脊柱侧凸包括长节段曲线，伴有尖锐畸形，在顶点产生巨大的不对称生长，采用截骨术和短节段融合无法很好地矫正。GR技术可能是最佳选择。然而，由于顶点处的尖锐畸形导致的巨大不对称生长潜力会增加并发症风险，尤其是植入物失败的风险。
方法
对7例（2例男性，5例女性）接受这种混合技术治疗严重僵硬型先天性脊柱侧凸的患者进行回顾性分析。查阅患者病历。分析内容包括初次手术时的年龄和最新随访情况、延长的次数和频率以及并发症。影像学评估包括测量脊柱侧凸Cobb角、胸椎后凸、腰椎前凸、躯干偏移、T1-S1长度以及内固定装置的变化。
结果
平均随访时间为53.3（30 - 77）个月。初次手术时的平均年龄为5.9（2 - 10）岁。每位患者平均延长5.3次。初次手术后脊柱侧凸平均从81.4°改善至40.1°，最新随访时为41.0°。平均每年T1-S1长度增加1.23 cm。肺可用空间比率从0.86增加至0.96。
结论
短节段融合截骨术有助于改善GR技术的矫正效果，并消除顶点周围的巨大不对称生长潜力，对脊柱长度影响较小。双GR技术可维持初次手术时获得的矫正效果，同时允许脊柱继续生长。这种混合技术可能是患有长节段先天性脊柱畸形且伴有尖锐畸形和巨大不对称生长潜力的年轻患者的一种选择。
证据级别
4级。
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