Larson A Noelle, Baky Fady J, St Hilaire Tricia, Pawelek Jeff, Skaggs David L, Emans John B, Pahys Joshua M
Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Spine Deform. 2019 Jan;7(1):152-157. doi: 10.1016/j.jspd.2018.05.011.
Retrospective review of prospectively collected data.
To compare the use of spine-based versus rib-based implants for the treatment of early-onset scoliosis (EOS) in the setting of rib fusions.
Treatment for severe early-onset spinal deformity with rib fusions includes growing spine devices with proximal rib or spine anchors. The results of treatment, however, have not been compared between spine-based versus rib-based proximal anchors.
169 patients with rib fusions treated with rib-based or spine-based constructs and minimum two-year follow-up were included. Sixteen patients were treated with proximal spine-based anchors and 153 with proximal rib-based devices (VEPTRs). Overall, 104 of the patients with rib-based fixation underwent thoracoplasty at the index surgery. We evaluated change in T1-T12 and T1-S1 height, coronal Cobb angle, kyphosis, and number of lengthening/revision surgeries.
Kyphosis increased a mean of 7° in the rib-based group and decreased a mean of 20 degrees in the spine-based group (p = .002). Major Cobb angle decreased in both groups (p < .0001); however, the spine-based group had greater Cobb angle improvement (24 vs. 11 degrees, p = .04). From implant and lengthening of distraction devices, there was a mean 3.3-cm (22%) increase in T1-T12 height and a mean of 8.0 lengthenings in the rib-based group compared with a 5.7-cm increase and 6.3 lengthening surgeries in the spine-based group. Patients with rib-based constructs had a mean of 11 total procedures, whereas spine-based patients had a mean of 8.
Patients underwent a mean of eight lengthening surgeries before final fusion or cessation of lengthening with a modest 2.3-cm increase in T1-T12 height. Compared with proximal rib anchors, proximal spine anchors controlled kyphosis and improved Cobb angle correction for early-onset scoliosis with rib fusions.
对前瞻性收集的数据进行回顾性分析。
比较在肋骨融合情况下，基于脊柱的植入物与基于肋骨的植入物在早发性脊柱侧弯（EOS）治疗中的应用。
严重早发性脊柱畸形合并肋骨融合的治疗方法包括使用近端肋骨或脊柱锚定的生长型脊柱器械。然而，基于脊柱的近端锚定物与基于肋骨的近端锚定物的治疗效果尚未进行比较。
纳入169例接受基于肋骨或基于脊柱的结构治疗且随访至少两年的肋骨融合患者。16例患者采用近端基于脊柱的锚定物治疗，153例采用近端基于肋骨的器械（垂直可扩张人工椎体，VEPTR）治疗。总体而言，104例接受基于肋骨固定的患者在初次手术时接受了胸廓成形术。我们评估了T1 - T12和T1 - S1高度、冠状面Cobb角、后凸畸形以及延长/翻修手术次数的变化。
基于肋骨的组后凸畸形平均增加7°，基于脊柱的组平均减少20°（p = 0.002）。两组的主要Cobb角均减小（p < 0.0001）；然而，基于脊柱的组Cobb角改善更大（24°对11°，p = 0.04）。从植入物和撑开装置的延长情况来看，基于肋骨的组T1 - T12高度平均增加3.3厘米（22%），平均延长8.0次，而基于脊柱的组T1 - T12高度增加5.7厘米，延长手术6.3次。接受基于肋骨结构治疗的患者平均共进行11次手术，而接受基于脊柱治疗的患者平均进行8次手术。
患者在最终融合或停止延长前平均接受8次延长手术，T1 - T12高度适度增加2.3厘米。与近端肋骨锚定物相比，近端脊柱锚定物可控制早发性脊柱侧弯合并肋骨融合患者的后凸畸形，并改善Cobb角矫正效果。
