Bas Can E, Preminger Jonathan, Olgun Zeynep D, Demirkiran Gokhan, Sponseller Paul, Yazici Muharrem
*Hacettepe University Hospitals, Hacettepe University Medical School, Ankara, Turkey †Johns Hopkins Bloomberg Children's Center, Baltimore, MD ‡Department of Orthopaedic Trauma, Hospital for Special Surgery, New York, NY.
J Pediatr Orthop. 2015 Dec;35(8):e98-103. doi: 10.1097/BPO.0000000000000419.
Thoracolumbar/lumbar kyphosis in myelomeningocele patients is a common and severely debilitating condition, amenable only to surgical correction. Several surgical techniques have been proposed. Growth-friendly techniques should be preferred in this patient population due to an already compromised trunk height. The growing rod (GR) and Luque trolley (LT) with Galveston instrumentation are well-known growth-friendly techniques. We compared results and complications in 2 groups of patients who have undergone kyphectomy and fixation, either with the GR (group 1) or the LT with Galveston pelvic fixation (group 2).
Ten patients undergoing GR fixation and 5 patients undergoing LT with Fackler fixation following kyphectomy (vertebral column resection or multiple eggshell) were included. GRs were lengthened every 6 months. Unplanned surgery in group 1 was defined as an unscheduled operation due to complication; all subsequent operations in group 2 were considered unplanned. Thoracic and local kyphosis and T1-S1 and T1-12 heights were measured preoperatively, postoperatively, and at final follow-up.
Mean age at initial surgery was 6 years and 6.5 years for groups 1 and 2, respectively. Mean age at the last follow-up was 12.5 years for group 1 and 13.1 years for group 2. Mean follow-up was 72.7 months for group 1 and 68.6 months for group 2. Preoperative, postoperative, and final follow-up kyphosis angles in that order for group 1 were 72.3 degrees (10 to 110 degrees), 16.9 degrees (-50 to +55 degrees), and 21.6 degrees (-41 to +97 degrees), and for group 2 106.6 degrees (81 to 132 degrees), 15.6 degrees (-37 to +50 degrees), and 19.2 degrees (-42 to +38 degrees), respectively. Postoperative and final follow-up in that order for mean T1-T12 and T1-S1 heights for group 1 were 14 (11.2 to 18.7) cm, 20.4 (19.3 to 25.7) cm and 21 (17.2 to 23.2) cm, 31.6 (23.6 to 41.5) cm. Postoperative and final follow-up in that order for mean T1-T12 and T1-S1 heights for group 2 were 15.9 (14.3 to 19.7) cm, 20.1 (15.5 to 24.6) cm and 24.4 (17.7 to 27.8) cm, 29.5 (25.3 to 31.3) cm. Growth per year was 1.05 and 0.84 cm for groups 1 and 2, respectively (P=0.297). Fourteen versus 4 unplanned surgeries were performed in groups 1 and 2, respectively, and an additional 4 implant revisions were performed in group 1 during planned lengthenings.
Both the LT and the GR system are reasonable alternatives of fixation postkyphectomy, both of which preserve growth to differing degrees. In this patient population with an already severely stunted trunk height, the surgeon must choose whether the amount of extra growth achieved by the GR is worth the risk of an increased number of surgeries.
脊髓脊膜膨出患者的胸腰段/腰椎后凸是一种常见且严重致残的病症，只能通过手术矫正。已经提出了几种手术技术。由于躯干高度已经受损，在该患者群体中应首选有利于生长的技术。生长棒（GR）和带有加尔维斯顿器械的卢克台车（LT）是众所周知的有利于生长的技术。我们比较了两组接受后凸切除术和固定术患者的结果和并发症，一组采用GR（第1组），另一组采用带有加尔维斯顿骨盆固定的LT（第2组）。
纳入10例行GR固定术的患者和5例行后凸切除术后（脊柱切除术或多次蛋壳技术）采用法克勒固定的LT手术的患者。GR每6个月延长一次。第1组的计划外手术定义为因并发症而进行的非计划手术；第2组的所有后续手术均视为计划外手术。在术前、术后和最终随访时测量胸段和局部后凸以及T1-S1和T1-12的高度。
第1组和第2组初次手术时的平均年龄分别为6岁和6.5岁。第1组最后一次随访时的平均年龄为12.5岁，第2组为13.1岁。第1组的平均随访时间为72.7个月，第2组为68.6个月。第1组术前、术后和最终随访时的后凸角度依次为72.3度（10至110度）、16.9度（-50至+55度）和21.6度（-41至+97度），第2组依次为106.6度（81至132度）、15.6度（-37至+50度）和19.2度（-42至+38度）。第1组术后和最终随访时T1-T12和T1-S1的平均高度依次为14（11.2至18.7）cm、20.4（19.3至25.7）cm以及21（17.2至23.2）cm、31.6（23.6至41.5）cm。第2组术后和最终随访时T1-T12和T1-S1的平均高度依次为15.9（14.3至19.7）cm、20.1（15.5至24.6）cm以及24.4（17.7至27.8）cm、29.5（25.3至31.3）cm。第1组和第2组每年的生长分别为1.05 cm和0.84 cm（P=0.297）。第1组和第2组分别进行了14次和4次计划外手术，第1组在计划延长期间还进行了4次植入物翻修手术。
LT和GR系统都是后凸切除术后固定的合理选择，两者都能不同程度地保留生长。在这个躯干高度已经严重发育迟缓的患者群体中，外科医生必须选择GR实现的额外生长量是否值得承担手术次数增加的风险。
