Antiel Ryan M, Riley John S, Cahill Patrick J, Campbell Robert M, Waqar Lindsay, Herkert Lisa M, Rintoul Natalie E, Peranteau William H, Flake Alan W, Adzick N Scott, Hedrick Holly L
The Center for Fetal Diagnosis and Treatment, Center for Thoracic Insufficiency Syndrome, and the Division of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
The Center for Fetal Diagnosis and Treatment, Center for Thoracic Insufficiency Syndrome, and the Division of Orthopedics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
J Pediatr Surg. 2016 Dec;51(12):1921-1925. doi: 10.1016/j.jpedsurg.2016.09.013. Epub 2016 Sep 15.
The purpose of this study was to evaluate the management and outcomes of CDH patients with scoliosis.
From January 1996 to August 2015, 26 of 380 (7%) CDH patients were diagnosed with scoliosis. Six (23%) were prenatally diagnosed by ultrasound, and 9 (35%) were diagnosed postnatally. The remaining 11 (42%) developed scoliosis after discharge. Mean follow-up was 6.6years.
Among the 15 patients with congenital scoliosis, there were 2 (13%) perinatal deaths. Five of the 13 (38%) survivors required orthopedic surgery, and 2 have required bracing. The mean age at initial surgery was 7years. These five children underwent an average of 2.8 (range 1-7) expansions or revisions. All surgical patients required supplemental oxygen at 28days of life, and 1 required a tracheostomy. None of the 11 patients who developed scoliosis later in life required surgery, but 3 have required bracing. Six of the 11 (55%) required a patch repair for CDH compared to 158 of 264 (60%) CDH patients without scoliosis (p=0.73).
Early diagnosis of scoliosis in CDH patients is associated with a high rate of surgery. There was not a higher incidence of patch repair among patients who developed scoliosis.
Prognosis. Retrospective study, level II.
本研究旨在评估先天性膈疝（CDH）合并脊柱侧弯患者的治疗及预后情况。
1996年1月至2015年8月，380例CDH患者中有26例（7%）被诊断为脊柱侧弯。其中6例（23%）在产前通过超声诊断，9例（35%）在产后诊断。其余11例（42%）在出院后出现脊柱侧弯。平均随访时间为6.6年。
15例先天性脊柱侧弯患者中，有2例（13%）围产期死亡。13例幸存者中有5例（38%）需要接受矫形手术，2例需要支具治疗。初次手术的平均年龄为7岁。这5名儿童平均接受了2.8次（范围1 - 7次）扩张或翻修手术。所有手术患者在出生后28天均需要补充氧气，1例需要气管切开术。11例后期出现脊柱侧弯的患者均无需手术，但3例需要支具治疗。11例脊柱侧弯患者中有6例（55%）需要进行CDH修补术，而264例无脊柱侧弯的CDH患者中有158例（60%）需要进行修补术（p = 0.73）。
CDH患者脊柱侧弯的早期诊断与高手术率相关。脊柱侧弯患者的修补术发生率并未更高。
预后。回顾性研究，二级。
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