Division of Spinal Surgery, University of Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, England.
Department of Orthopaedic Surgery and Musculoskeletal Medicine, Canterbury School of Medicine, Univeristy of Otago,Christchurch, New Zealand.
Spine (Phila Pa 1976). 2018 Oct 15;43(20):E1225-E1231. doi: 10.1097/BRS.0000000000002668.
Prospective cohort study OBJECTIVE.: To understand the efficacy of a tail-gating technique (TGT) to mirror the normal spinal growth of children with early-onset scoliosis (EOS) treated with magnetically controlled growing rods (MCGR).
MCGR allow outpatient distraction and guided spinal growth without the need for repeat surgery. Two techniques (maximal and targeted) are currently employed to determine the distraction amount, however the efficacy of each is unknown. This study specifically assesses the ability of targeted distraction to achieve physiological growth.
We performed a retrospective review of European children treated with MCGR using a TGT and analyzed the post-operative clinical and radiographic outcomes, including the sitting height, standing height, coronal Cobb angle, T1-T12 and T1-S1 height. Furthermore, we compared the post-operative sitting/standing height ratio every 6 months to those reported for normal age- and sex-matched European children.
Thirty-five children were included with a mean follow-up of 3.4 years (1.8-5.8 years). All clinical and radiographic parameters significantly (P < 0.05) improved immediately post-operatively and were maintained until final follow-up. The TGT mirrored the normative sitting/standing height ratios for expected spinal growth (Pearson correlation 0.95 for males and 0.90 for females). The mean difference between the reference values for the sitting/standing height ratio and our results was 0.0124 (P < 0.001) for males and 0.0068 (P = 0.010) for females.
MCGR can reliably improve the coronal deformity in children with EOS while maintaining spinal growth. A TGT to determine the distraction amount at follow-up accurately mirrors the normal growth pattern of age-, sex-, and ethnicity-matched children. However, patients treated with this technique have a statistically significant, but clinically insignificant, shorter than physiologically normal spinal height.
前瞻性队列研究
了解尾进式技术（TGT）在治疗早发性脊柱侧凸（EOS）儿童使用磁控生长棒（MCGR）的情况下，对模拟儿童正常脊柱生长的疗效。
MCGR 允许门诊患者进行分散注意力和引导脊柱生长，而无需再次手术。目前采用两种技术（最大和靶向）来确定分散量，但每种技术的效果未知。本研究专门评估了靶向分散实现生理生长的能力。
我们对使用 TGT 治疗的欧洲儿童进行了回顾性研究，并分析了术后临床和影像学结果，包括坐高、立高、冠状 Cobb 角、T1-T12 和 T1-S1 高度。此外，我们将术后每 6 个月的坐/立高比与正常年龄和性别匹配的欧洲儿童的报告进行了比较。
共纳入 35 名儿童，平均随访 3.4 年（1.8-5.8 年）。所有临床和影像学参数在术后即刻均显著（P<0.05）改善，并维持至最终随访。TGT 模拟了预期脊柱生长的正常坐/立高比（男性 Pearson 相关系数为 0.95，女性为 0.90）。参考值与我们的结果之间的坐/立高比的平均差异为男性 0.0124（P<0.001），女性 0.0068（P=0.010）。
MCGR 可可靠地改善早发性脊柱侧凸儿童的冠状畸形，同时维持脊柱生长。在随访时确定分散量的 TGT 准确地模拟了与年龄、性别和种族匹配的儿童的正常生长模式。然而，接受这种技术治疗的患者的脊柱高度明显短于生理正常，但具有统计学意义，临床上意义不大。
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