Dede Ozgur, Demirkiran Gokhan, Yazici Muharrem
Hacettepe Universitesi Hastanesi, Ortopedi ve Travmatoloji Anabilim Dali, Sihhiye, Ankara, Turkey.
Curr Opin Pediatr. 2014 Feb;26(1):57-63. doi: 10.1097/MOP.0000000000000036.
Spinal fusion procedures that are the mainstay of the treatment of progressive or severe curves in adolescents and adults are not suitable for most young children as there is a large magnitude of remaining growth. Early spinal fusion stunts the growth of the thorax and may interfere with the development of the lungs. Therefore, in children with early-onset scoliosis, 'growth friendly' instrumentation systems have been utilized to control the deformity while allowing the growth of the spine and the thoracic cage.
The experience with growing rods has been increasing, along with expanding indications. Several self-lengthening instrumentation systems have been introduced aiming for guided spinal growth. There has been considerable progress in the clinical and laboratory studies using magnetically controlled growing rod constructs. Growing rods and vertical expandable prosthetic titanium rib (VEPTR) systems provide deformity control while allowing for spinal growth along with a risk of spontaneous vertebral fusions. VEPTR may cause rib fusions as the implants overlie the thoracic cage and, therefore, the use in pure spinal deformities is controversial.
There have been exciting recent advances concerning the treatment of spinal deformities in young children. Despite these advances, the surgical treatment of early-onset scoliosis remains far from optimal and more development is on the way.
脊柱融合手术是青少年和成人进行性或严重脊柱侧弯治疗的主要手段，但由于大多数幼儿仍有大量剩余生长，该手术并不适合他们。早期脊柱融合会阻碍胸廓生长，并可能干扰肺部发育。因此，对于早发性脊柱侧弯患儿，已采用“生长友好型”器械系统来控制畸形，同时允许脊柱和胸廓生长。
随着适应证的扩大，生长棒的应用经验不断增加。为引导脊柱生长，已推出多种自延长器械系统。在使用磁控生长棒结构的临床和实验室研究方面取得了显著进展。生长棒和垂直可扩张人工钛肋（VEPTR）系统在控制畸形的同时，允许脊柱生长，但存在自发椎体融合的风险。VEPTR可能会导致肋骨融合，因为植入物覆盖在胸廓上，因此其在单纯脊柱畸形中的应用存在争议。
近期在幼儿脊柱畸形治疗方面取得了令人兴奋的进展。尽管如此，早发性脊柱侧弯的外科治疗仍远未达到最佳效果，未来还有更多的发展。
