连续生长棒延长术对早发性脊柱侧凸矢状面形态和骨盆参数的影响。
The effect of serial growing rod lengthening on the sagittal profile and pelvic parameters in early-onset scoliosis.
作者信息
Shah Suken A, Karatas Ali F, Dhawale Arjun A, Dede Ozgur, Mundis Gregory M, Holmes Laurens, Yorgova Petya, Neiss Geraldine, Johnston Charles E, Emans John B, Thompson George H, Pawelek Jeff B, Akbarnia Behrooz A
机构信息
*Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE †San Diego Center for Spinal Disorders, La Jolla, CA ‡Texas Scottish Rite Hospital for Children, Dallas, TX §Boston Children's Hospital, Boston, MA; and ¶Case Western Reserve University, Cleveland, OH.
出版信息
Spine (Phila Pa 1976). 2014 Oct 15;39(22):E1311-7. doi: 10.1097/BRS.0000000000000565.
STUDY DESIGN
Retrospective case series.
OBJECTIVE
To report the effect of repeated growing rod (GR) lengthenings on the sagittal and pelvic profile in patients with early-onset scoliosis.
SUMMARY OF BACKGROUND DATA
Posterior distraction-based GRs have gained popularity as a technique for the surgical management of early-onset scoliosis. However, there are no published studies on the effect of serial GR lengthenings on sagittal balance, thoracic kyphosis (TK), lumbar lordosis (LL), and pelvic parameters.
METHODS
We retrospectively reviewed data from a multicenter early-onset scoliosis database. Forty-three patients who were able to walk with minimum 2-year follow-up who underwent single- or dual-GR surgery were included for review. Mean number of lengthenings was 6.4 (range, 3-16). Mean preoperative age was 5.6 years (standard deviation, 2.4 yr), and mean follow-up was 3.5 years. Maximum TK, LL, and sagittal balance were assessed preoperatively, after index surgery, and at the latest follow-up.
RESULTS
There was a significant decrease both in TK and LL after index surgery, which then increased during the lengthening period. There was a significant increase in both proximal junctional kyphosis and distal junctional angle. Pelvic parameters (pelvic tilt, pelvic incidence, sacral slope) were unchanged during the treatment period. Significant improvement was observed in sagittal balance. There was a correlation between the change in TK and change in LL.
CONCLUSION
TK decreased after index surgery and increased between the index surgery and the latest follow-up, which was accompanied by an increase in LL. All-screw proximal constructs had mean 9° more proximal junctional kyphosis than all-hook proximal constructs. An increase in proximal junctional kyphosis and distal junctional angle was found during the treatment period. Although there was an independent effect of number of lengthenings on TK, there was no significant detrimental effect on other sagittal spinopelvic parameters. GRs had a positive effect on sagittal vertical axis, which returned patients to a more neutral alignment through the course of treatment.
LEVEL OF EVIDENCE
研究设计
回顾性病例系列研究。
目的
报告反复进行生长棒（GR）延长术对早发性脊柱侧凸患者矢状面和骨盆形态的影响。
背景数据总结
基于后路撑开的生长棒作为早发性脊柱侧凸手术治疗技术已得到广泛应用。然而，尚无关于系列生长棒延长术对矢状面平衡、胸椎后凸（TK）、腰椎前凸（LL）和骨盆参数影响的发表研究。
方法
我们回顾性分析了一个多中心早发性脊柱侧凸数据库中的数据。纳入43例接受单根或双根生长棒手术且能行走、随访至少2年的患者进行分析。平均延长次数为6.4次（范围3 - 16次）。术前平均年龄为5.6岁（标准差2.4岁），平均随访3.5年。在术前、初次手术后及末次随访时评估最大TK、LL和矢状面平衡。
结果
初次手术后TK和LL均显著降低，在延长期间又升高。近端交界性后凸和远端交界角均显著增加。治疗期间骨盆参数（骨盆倾斜、骨盆入射角、骶骨斜率）无变化。矢状面平衡有显著改善。TK变化与LL变化之间存在相关性。
结论
初次手术后TK降低，在初次手术至末次随访期间升高，同时LL增加。全螺钉近端结构的近端交界性后凸比全钩近端结构平均多9°。治疗期间发现近端交界性后凸和远端交界角增加。尽管延长次数对TK有独立影响，但对其他矢状面脊柱骨盆参数无显著不良影响。生长棒对矢状垂直轴有积极影响，在治疗过程中使患者恢复到更中立的对线。
证据级别
4级。
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