磁控生长棒矫形术治疗早发性脊柱侧凸的计划性翻修手术：至少 2 年随访结果
Unplanned Reoperations in Magnetically Controlled Growing Rod Surgery for Early Onset Scoliosis With a Minimum of Two-Year Follow-Up.
机构信息
Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
Acibadem University School of Medicine, Istanbul, Turkey.
出版信息
Spine (Phila Pa 1976). 2017 Dec 15;42(24):E1410-E1414. doi: 10.1097/BRS.0000000000002297.
STUDY DESIGN
A retrospective review of prospectively collected clinical and radiologic data of patients with magnetically controlled growing rods (MCGRs) from a multi-centered study with a minimum of 2-year follow-up.
OBJECTIVE
The aim of this study was to describe the incidence and causes of unplanned reoperations and to report the outcomes of patients treated with MCGR for early-onset scoliosis (EOS).
SUMMARY OF BACKGROUND DATA
Published clinical studies have demonstrated that MCGR is safe and effective for curvature control of EOS, and can avoid repeated surgeries for distractions. However, there have been no reports on the unplanned reoperations and complications of MCGR for EOS with a large series of patients.
METHODS
Between 2009 and 2012, 30 patients with EOS underwent MCGR implantation in six institutions. A retrospective review of prospectively collected clinical and radiologic data with a minimum of 2-year follow-up was conducted. Demographic data, radiologic measurements, unplanned reoperations, and other complications were noted. Risk factors for unplanned reoperations were analyzed.
RESULTS
Patients underwent MCGR implantation at the mean age of 7.2 years. The mean follow-up period was 37 months. Fourteen patients (46.7%) underwent an unplanned reoperation within the follow-up period, with a mean time to reoperation of 23 months after initial surgery (range, 5-48 months). Causes of unplanned reoperation were failure of rod distractions, proximal foundation failure, rod breakage, and infection. More frequent distractions (between 1 week and 2 months) were associated with a higher rate of reoperation than distraction frequencies between 3 and 6 months (71% vs. 25%).
CONCLUSION
This is the largest series with the longest follow-up to date that examines the need for additional unplanned surgery after the initial procedure. It highlights that MCGR surgery can be associated with unplanned reoperations, and more frequent distractions may be a risk factor. Long-term comparative studies with traditional growing rod are required to evaluate the effectiveness of this implant.
LEVEL OF EVIDENCE
研究设计
对一项多中心前瞻性研究中至少 2 年随访的患者的临床和影像学数据进行回顾性分析，这些患者使用的是磁控生长棒（MCGR）。
目的
本研究旨在描述计划外再次手术的发生率和原因，并报告使用 MCGR 治疗特发性脊柱侧凸（EOS）患者的结果。
背景资料总结
已发表的临床研究表明，MCGR 安全有效，可控制 EOS 的脊柱侧凸，避免因延长器而反复手术。然而，对于大量患者使用 MCGR 治疗 EOS 的计划外再次手术和并发症尚无报道。
方法
2009 年至 2012 年，在六家机构中，30 名 EOS 患者接受了 MCGR 植入。对至少 2 年随访的前瞻性收集的临床和影像学数据进行回顾性分析。记录患者的人口统计学数据、影像学测量值、计划外再次手术和其他并发症。分析计划外再次手术的危险因素。
结果
患者在平均 7.2 岁时接受 MCGR 植入。平均随访时间为 37 个月。14 名患者（46.7%）在随访期间进行了计划外再次手术，初次手术后的平均再手术时间为 23 个月（范围，5-48 个月）。计划外再次手术的原因包括延长器失效、近端基础失效、棒断裂和感染。更频繁的延长（1 周至 2 个月之间）与更高的再手术率相关，而 3 至 6 个月之间的延长与较低的再手术率相关（71%与 25%）。
结论
这是迄今为止对初次手术后是否需要进一步计划外手术进行检查的最大系列研究，也是随访时间最长的研究。它强调了 MCGR 手术可能与计划外再次手术相关，更频繁的延长可能是一个危险因素。需要进行长期的传统生长棒对比研究来评估该植入物的有效性。
证据等级
4 级。
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