Marqués Carlos, Pizones Javier, Sánchez-Márquez José Miguel, Martín-Baldan Montserrat, Fernández-Baíllo Nicomedes, Sánchez Pérez-Grueso Francisco Javier
Department of Orthopaedic Surgery, Complejo Asistencial Universitario de Salamanca, Paseo de San Vicente, 58, Salamanca 37007, Spain.
Spine Unit, Department of Orthopaedic Surgery, Hospital Universitario La Paz, Paseo de la Castellana, 261, Madrid, Spain.
Spine Deform. 2019 Jan;7(1):180-185. doi: 10.1016/j.jspd.2018.06.016.
Report of four cases.
To describe a series of pediatric patients with surgical scoliosis after chest wall resections due to Askin tumors.
Askin tumors are a rare type of chest wall solid tumors that can develop in children. Treatment involves chemotherapy and extensive surgical resection, including disarticulation of several ribs. This can cause thoracogenic scoliosis, with very scarce data found in the literature regarding its treatment and prognosis.
Retrospective descriptive series of four cases of scoliosis in pediatric patients, secondary to extensive chest resections due to Akin's tumors. We analyzed the results of the surgical treatment.
Three girls and one boy with a mean age of 8.7 ± 2.2 years and 7 ± 3.6 years of follow-up were included. In all cases, the convexity of the thoracic curvature was toward the area of chest resection, occurring a mean of 1.9±1.3 years after thoracic surgery. A distraction-based system (two vertically expandable prosthetic titanium rib [VEPTR], two traditional growing rods) was used to correct the scoliosis. The preoperative Cobb angle (68.7° ± 22.9°) was corrected to 32.6° ± 9.7° at final follow-up. Preoperative coronal imbalance was 2.95 ± 1.86 cm and was corrected to 0.3 ± 0.6 cm at final follow-up. No changes were observed regarding preoperative kyphosis 30° ± 8.7° (33°±8° final). T1-S1 initial length was 29.65 cm changing to 40.65 cm. T1-T12 height went from 18.25 to 23.67 cm. There was one complication secondary to the proximal anchoring.
For treatment of scoliosis secondary to extensive chest resection in the growing children with Askin tumors, distraction-based growth-friendly treatment is an available surgical option. Seven years of follow-up showed more than 50% improvement of the Cobb angle, and an average thoracic and trunk growth of 5.42 and 11 cm, respectively.
Level IV.
4例病例报告。
描述一系列因Askin肿瘤行胸壁切除术后出现手术性脊柱侧弯的儿科患者。
Askin肿瘤是一种罕见的儿童胸壁实体肿瘤。治疗包括化疗和广泛的手术切除，包括多根肋骨的关节离断。这可导致胸廓源性脊柱侧弯，而关于其治疗和预后的文献资料非常稀少。
对4例儿科患者因Akin肿瘤行广泛胸壁切除术后继发脊柱侧弯的病例进行回顾性描述性系列研究。我们分析了手术治疗的结果。
纳入3名女孩和1名男孩，平均年龄8.7±2.2岁，随访7±3.6年。所有病例中，胸弯凸向胸壁切除区域，平均发生在胸壁手术后1.9±1.3年。采用基于撑开的系统（两根垂直可扩展人工钛肋[VEPTR]，两根传统生长棒）矫正脊柱侧弯。末次随访时，术前Cobb角（68.7°±22.9°）矫正至32.6°±9.7°。术前冠状面失平衡为2.95±1.86 cm，末次随访时矫正至0.3±0.6 cm。术前后凸角30°±8.7°（末次为33°±8°）无变化。T1-S1初始长度为29.65 cm，变为40.65 cm。T1-T12高度从18.25 cm增至23.67 cm。近端固定继发1例并发症。
对于患有Askin肿瘤的生长发育中的儿童，因广泛胸壁切除继发脊柱侧弯的治疗，基于撑开的利于生长的治疗是一种可行的手术选择。7年的随访显示Cobb角改善超过50%，胸廓和躯干平均生长分别为5.42 cm和11 cm。
IV级。
