Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany.
Department of Trauma, Orthopaedic and Plastic Surgery, University Medical Center Goettingen, Robert-Koch-Straße 40, 37075 Goettingen, Germany.
Spine J. 2018 Apr;18(4):567-574. doi: 10.1016/j.spinee.2017.08.244. Epub 2017 Aug 24.
In several studies, vertical expandable prosthetic titanium rib (VEPTR) implants have shown good scoliosis control in children with the longest reported follow-up of 3.6 years. For growing rods, recent studies suggest a decreased efficiency of correction starting just after that time. To our knowledge, no long-term results of children with VEPTR treatment are available.
This study aimed to evaluate spinal deformity in scoliotic children and to investigate correction potential of VEPTR implants at several time points of treatment, particularly after long-term follow-up.
STUDY DESIGN/SETTING: We performed a retrospective case series of 32 children with spinal deformity and VEPTR treatment with analysis of clinical and radiological data pre- and post-VEPTR implantation and every 2 years during the follow-up period.
Thirty-two patients with spinal deformity and VEPTR treatment comprised the patient sample.
Patients had a primary VEPTR implantation due to spinal deformity and thoracic insufficiency syndrome and repeated lengthening procedures every 6 months. Clinical data were assessed and radiological parameters were analyzed. The main thoracic scoliotic curve and associated curves as well as kyphosis, lordosis, pelvic obliquity, and spinal length were measured in all radiographs until the end of VEPTR treatment or the last available examination.
Development of the different parameters during follow-up was evaluated and statistical analysis was performed with Statistica version 13.0. No funding was obtained for this study. The authors have no conflicts of interest to declare.
Directly after VEPTR implantation, thoracic and lumbar curves corrected significantly, were stable at 2.8-year follow-up, and increased at 5.5-year follow-up, whereas cervical scoliosis was not affected by the treatment. The sagittal profile was initially improved both in kyphosis and lordosis. However, at 5.5-year follow-up, hyperkyphosis had deteriorated beyond the initial deformity. Pelvic obliquity was significantly restored especially in neuromuscular patients, and increasing spinal length was achieved within the 5.5-year follow-up.
In children with spinal deformity, implantation of the VEPTR device sufficiently corrected the deformity in all planes. During long-term follow-up, scoliosis increased slightly and was rather well controlled, whereas the implant system was not able to prevent deterioration of hyperkyphosis. Pelvic obliquity was well balanced and spinal lengthening was achieved during long-term follow-up.
在几项研究中，垂直可扩张钛肋骨假体（VEPTR）植入物在患有脊柱侧弯的儿童中显示出良好的脊柱侧弯控制效果，最长的随访时间为 3.6 年。对于生长棒，最近的研究表明，在那个时间之后，矫正效果开始降低。据我们所知，目前还没有 VEPTR 治疗儿童的长期结果。
本研究旨在评估脊柱侧弯儿童的脊柱畸形，并研究 VEPTR 植入物在治疗过程中的多个时间点的矫正潜力，特别是在长期随访后。
研究设计/设置：我们对 32 例接受 VEPTR 治疗的脊柱畸形儿童进行了回顾性病例系列研究，分析了 VEPTR 植入前后及随访期间每 2 年的临床和影像学数据。
32 例脊柱畸形伴 VEPTR 治疗的患者为研究对象。
患者因脊柱畸形和胸壁发育不全综合征接受初次 VEPTR 植入，并每 6 个月进行一次延长手术。评估了临床数据，并分析了影像学参数。在所有 X 光片中测量了主要胸椎侧凸和相关曲线以及后凸、前凸、骨盆倾斜和脊柱长度，直到 VEPTR 治疗结束或最后一次可获得的检查。
评估了随访期间不同参数的发展，并使用 Statistica 版本 13.0 进行了统计分析。本研究未获得任何资金支持。作者没有利益冲突需要声明。
VEPTR 植入后，胸椎和腰椎曲线显著矫正，2.8 年随访时保持稳定，5.5 年随访时增加，而颈椎侧凸不受治疗影响。矢状位曲线最初在后凸和前凸方面都得到了改善。然而，在 5.5 年随访时，超后凸已经恶化到初始畸形之外。骨盆倾斜得到了显著改善，尤其是在神经肌肉疾病患者中，并且在 5.5 年随访期间实现了脊柱长度的增加。
在患有脊柱畸形的儿童中，VEPTR 装置的植入在所有平面上都充分矫正了畸形。在长期随访中，脊柱侧弯略有增加，但得到了很好的控制，而植入物系统未能防止超后凸的恶化。骨盆倾斜得到很好的平衡，在长期随访中实现了脊柱延长。
