Department of Orthopaedic Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Spine (Phila Pa 1976). 2017 Dec 1;42(23):E1366-E1370. doi: 10.1097/BRS.0000000000002168.
Prospective comparative study.
To evaluate whether weight percentile (WP) increases after vertical expandable prosthetic titanium rib (VEPTR) insertion, and whether WP correlates with nutrition laboratories and pulmonary function.
Children with thoracic insufficiency syndrome often have "failure to thrive" (WP ≤5). Previous authors have reported an increase in WP after VEPTR surgery. Weight gain was hypothesized to be secondary to improved pulmonary function. The presence of a correlation between WP and nutrition laboratories and pulmonary function tests (PFT) after VEPTR insertion has not been studied.
Demographic, nutrition, radiographic, and PFT data were collected on 35 VEPTR patients with a minimum follow-up of 2 years. The relationship between WP and nutrition laboratories and pulmonary function was analyzed.
Preoperative WP was ≤5 (PREOP≤5) in 13 patients (37%) and >5 (PREOP>5) in 22 patients (63%). Although all children gained weight, the PREOP≤5 group was more likely to have an increase in WP (P = 0.014). Sixty-eight percent of the PREOP>5 group had a decrease in WP and 32% of the PREOP>5 patients met the criteria for failure to thrive at final follow-up. Overall, there was no change in the number of children with a WP ≤5 (13 vs. 15). Forty-two percent of the children who maintained or increased their WP had a gastrostomy tube, compared to 19% of those who decreased their WP. Seventy-three percent of the patients with failure to thrive at final follow-up did not have a gastrostomy tube. No significant correlations were found between WP and nutrition laboratories, radiographic measures, or PFTs.
We did not find an overall change in WP after VEPTR insertion. We did not find any correlation between WP and nutrition laboratories or pulmonary function. Weight gain after VEPTR surgery may be secondary to nutritional optimization in high-risk patients. Children who do not have failure to thrive at presentation also require attention.
前瞻性对照研究。
评估垂直扩张性假体钛肋骨（VEPTR）插入后体重百分位数（WP）是否增加，以及 WP 是否与营养实验室和肺功能相关。
胸壁发育不全综合征患儿常出现“生长不良”（WP≤5）。先前的作者报告 VEPTR 手术后 WP 增加。假设体重增加是由于肺功能改善所致。VEPTR 手术后 WP 与营养实验室和肺功能测试（PFT）之间是否存在相关性尚未研究。
收集 35 例 VEPTR 患者的人口统计学、营养、影像学和 PFT 数据，随访时间至少 2 年。分析 WP 与营养实验室和肺功能的关系。
术前 WP 为≤5（PREOP≤5）的患者有 13 例（37%），>5（PREOP>5）的患者有 22 例（63%）。尽管所有患儿体重均增加，但 PREOP≤5 组 WP 增加的可能性更大（P=0.014）。PREOP>5 组中有 68%的患者 WP 下降，32%的 PREOP>5 患者在最终随访时符合生长不良的标准。总体而言，WP≤5 的患儿数量没有变化（13 例与 15 例）。维持或增加 WP 的患儿中有 42%有胃造口管，而 WP 下降的患儿中有 19%有胃造口管。最终随访时生长不良的患者中，有 73%没有胃造口管。未发现 WP 与营养实验室、影像学测量或 PFT 之间存在显著相关性。
我们没有发现 VEPTR 插入后 WP 总体变化。我们没有发现 WP 与营养实验室或肺功能之间存在任何相关性。VEPTR 手术后体重增加可能是高危患者营养优化的结果。即使在就诊时没有生长不良的患儿也需要关注。
2 级。
