生长棒治疗早发性脊柱侧弯后的最终融合：这真的是最终结果吗？
Final Fusion After Growing-Rod Treatment for Early Onset Scoliosis: Is It Really Final?
作者信息
Poe-Kochert Connie, Shannon Claire, Pawelek Jeff B, Thompson George H, Hardesty Christina K, Marks David S, Akbarnia Behrooz A, McCarthy Richard E, Emans John B
机构信息
Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio.
Growing Spine Foundation, San Diego, California.
出版信息
J Bone Joint Surg Am. 2016 Nov 16;98(22):1913-1917. doi: 10.2106/JBJS.15.01334.
BACKGROUND
Final fusion is thought to be the end point for patients with early onset scoliosis following treatment with the use of growing rods. But is it? The purpose of this study was to determine the incidence and cause of any reoperation after final fusion.
METHODS
A multicenter database of patients with early onset scoliosis was retrospectively analyzed to identify patients treated with growing rods with a minimum of 2 years of follow-up after final fusion. All reoperations were recorded. Reoperation was defined as a return to the operating room for any complication related to the final fusion surgery or etiology of the spinal deformity.
RESULTS
One hundred (84%) of 119 patients met the inclusion criteria: for 38 of the patients, the etiology of scoliosis was neuromuscular; for 31, syndromic; for 22, idiopathic; and for 9, congenital. The mean age at final fusion was 12.2 years (range, 8.5 to 18.7 years). The mean follow-up after final fusion was 4.3 years (range, 2 to 11.2 years). Twenty (20%) of the patients had 30 complications requiring reoperation (57 procedures). There was a mean of 1.5 complications per patient after final fusion. Eight patients with neuromuscular scoliosis, 8 with syndromic, 4 with idiopathic, and no patient with congenital scoliosis required reoperation. Nine (9%) of the patients experienced infection (33 reoperation procedures); 6 (6%) had instrumentation failure (8 procedures); 5 (5%) had painful or prominent instrumentation (6 procedures); 3 (3%) each had coronal deformity (3 procedures), pseudarthrosis (3 procedures), or sagittal deformity (3 procedures); and 1 (1%) had progressive crankshaft chest wall deformity requiring a thoracoplasty (1 procedure).
CONCLUSIONS
A higher-than-anticipated percentage of patients treated with growing rods required unplanned reoperation following final fusion. Long-term follow-up after final fusion is necessary to determine true final results. Patients and parents need to be counseled regarding the possibility of further surgery after final fusion.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
背景
最终融合被认为是早发性脊柱侧凸患者使用生长棒治疗后的终点。但事实如此吗？本研究的目的是确定最终融合后再次手术的发生率及原因。
方法
对一个早发性脊柱侧凸患者的多中心数据库进行回顾性分析，以确定接受生长棒治疗且最终融合后至少随访2年的患者。记录所有再次手术情况。再次手术定义为因与最终融合手术或脊柱畸形病因相关的任何并发症而返回手术室。
结果
119例患者中有100例（84%）符合纳入标准：38例患者脊柱侧凸病因是神经肌肉性；31例是综合征性；22例是特发性；9例是先天性。最终融合时的平均年龄为12.2岁（范围8.5至18.7岁）。最终融合后的平均随访时间为4.3年（范围2至11.2年）。20例（20%）患者出现30种需要再次手术的并发症（57次手术）。最终融合后每位患者平均有1.5种并发症。8例神经肌肉性脊柱侧凸患者、8例综合征性患者、4例特发性患者需要再次手术，先天性脊柱侧凸患者无需要再次手术者。9例（9%）患者发生感染（33次再次手术）；6例（6%）出现内固定失败（8次手术）；5例（5%）有疼痛或突出的内固定（6次手术）；3例（3%）分别出现冠状面畸形（3次手术）、假关节形成（3次手术）或矢状面畸形（3次手术）；1例（1%）出现进展性曲轴胸壁畸形需要胸廓成形术（1次手术）。
结论
使用生长棒治疗的患者在最终融合后需要进行计划外再次手术的比例高于预期。最终融合后需要长期随访以确定真正的最终结果。需要向患者及家长告知最终融合后可能需要进一步手术的情况。
证据水平
治疗性四级。有关证据水平的完整描述，请参阅作者指南。
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