Chen Zhonghui, Li Song, Qiu Yong, Zhu Zezhang, Chen Xi, Xu Liang, Sun Xu
J Neurosurg Pediatr. 2017 Dec;20(6):561-566. doi: 10.3171/2017.7.PEDS17233. Epub 2017 Oct 6.
OBJECTIVE Although the vertical expandable prosthetic titanium rib (VEPTR) and growing rod instrumentation (GRI) encourage spinal growth via regular lengthening, they can create different results because of their different fixation patterns and mechanisms in correcting scoliosis. Previous studies have focused comparisons on coronal plane deformity with minimal attention to the sagittal profile. In this retrospective study, the authors aimed to compare the evolution of the sagittal spinal profile in early-onset scoliosis (EOS) treated with VEPTR versus GRI. METHODS The data for 11 patients with VEPTR and 22 with GRI were reviewed. All patients had more than 2 years' follow-up with more than 2 lengthening procedures. Radiographic measurements were performed before and after the index surgery and at the latest follow-up. The complications in both groups were recorded. RESULTS Patients in both groups had similar diagnoses, age at the index surgery, and number of lengthening procedures. The changes in the major coronal Cobb angle and T1-S1 spinal height were not significantly different between the 2 groups. Compared with the GRI group, the VEPTR group had less correction in thoracic kyphosis (23% ± 12% vs 44% ± 16%, p < 0.001) after the index surgery and experienced a greater correction loss in thoracic kyphosis (46% ± 18% vs 11% ± 8%, p < 0.001) at the latest follow-up. Although the increase in the proximal junctional angle was not significantly different (VEPTR: 7° ± 4° vs GRI: 8° ± 5°, p = 0.569), the incidence of proximal junctional kyphosis was relatively lower in the VEPTR group (VEPTR: 18.2% vs GRI: 22.7%). No significant changes in the spinopelvic parameters were observed, while the sagittal vertical axis showed a tendency toward a neutral position in both groups. The overall complication rate was higher in the VEPTR group than in the GRI group (72.7% vs 54.5%). CONCLUSIONS The VEPTR had coronal correction and spinal growth results similar to those with GRI. In the sagittal plane, however, the VEPTR was not comparable to the GRI in controlling thoracic kyphosis. Thus, for hyperkyphotic EOS patients, GRI is recommended over VEPTR.
尽管垂直可扩张人工钛肋骨（VEPTR）和生长棒器械（GRI）通过定期延长来促进脊柱生长，但由于它们在矫正脊柱侧弯时的固定方式和机制不同，可能会产生不同的结果。以往的研究主要集中在冠状面畸形的比较上，而对矢状面形态关注较少。在这项回顾性研究中，作者旨在比较接受VEPTR与GRI治疗的早发性脊柱侧弯（EOS）患者矢状面脊柱形态的演变情况。方法：回顾了11例接受VEPTR治疗和22例接受GRI治疗患者的数据。所有患者均接受了超过2年的随访且进行了超过2次的延长手术。在初次手术前后及最新随访时进行影像学测量。记录两组的并发症情况。结果：两组患者的诊断、初次手术年龄及延长手术次数相似。两组之间主要冠状面Cobb角和T1-S1脊柱高度的变化无显著差异。与GRI组相比，VEPTR组在初次手术后胸椎后凸矫正较少（23%±12% vs 44%±16%，p<0.001），且在最新随访时胸椎后凸矫正丢失更多（46%±18% vs 11%±8%，p<0.001）。尽管近端交界角的增加无显著差异（VEPTR：7°±4° vs GRI：8°±5°，p = 0.569），但VEPTR组近端交界后凸的发生率相对较低（VEPTR：18.2% vs GRI：22.7%）。未观察到脊柱骨盆参数有显著变化，而两组的矢状垂直轴均有趋于中立位的趋势。VEPTR组的总体并发症发生率高于GRI组（72.7% vs 54.5%）。结论：VEPTR在冠状面矫正和脊柱生长方面的结果与GRI相似。然而，在矢状面，VEPTR在控制胸椎后凸方面无法与GRI相媲美。因此，对于后凸严重的EOS患者，推荐使用GRI而非VEPTR。
