Hybrid 生长棒技术结合短节段融合和脊柱牵张：长节段先天性脊柱侧凸的另一种解决方案。
Hybrid Growing Rod Technique of Osteotomy With Short Fusion and Spinal Distraction: An Alternative Solution for Long-Spanned Congenital Scoliosis.
机构信息
Department of Spine Surgery, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China.
出版信息
Spine (Phila Pa 1976). 2019 May 15;44(10):707-714. doi: 10.1097/BRS.0000000000002933.
STUDY DESIGN
Retrospective study.
OBJECTIVE
The current study aimed to evaluate the effectiveness of the hybrid growing rod (GR) technique for the treatment of young children with congenital scoliosis (CS).
SUMMARY OF BACKGROUND DATA
Congenital vertebral anomalies within long-spanned kyphoscoliosis were difficult to be managed by either definitive spinal fusion or standard GR technique. Hybrid technique of one-stage posterior osteotomy with short fusion and GR distraction was proposed in previous studies. There is, however, paucity of data regarding its effectiveness.
METHODS
Thirteen patients (mean age, 5.4 ± 2.0 yr) who had undergone hybrid GR treatment were retrospectively reviewed, including 8 patients treated with single GR and 5 patients with dual GR. All of their radiographic data were measured, and surgical complications were recorded.
RESULTS
On average, the current cohort had 4.1 ± 1.7 lengthening procedures. After the index surgery, the major curve improved remarkably from 86.4° ± 11.9° to 37.3° ± 12.4° (P < 0.001). The global kyphosis significantly decreased from 66.8° ± 16.1° to 33.3° ± 3.5° postoperatively. Both value remained steady during follow-up. There were no significant difference between single GR and dual GR groups in terms of the coronal deformity correction, whereas correction loss of global kyphosis in single GR group was significantly higher than that in dual GR group (P = 0.039). After the index surgery, T1-S1 height averagely gained 4.4 ± 0.8 cm and it grew at an average rate of 1.31 ± 0.24 cm/yr during the follow-up. Two complications were identified in two patients, including one with rod fracture and one with proximal junctional kyphosis.
CONCLUSION
The hybrid GR technique was effective in correcting spinal deformity and allowing continuous spinal growth. The optimal indications were young children with apical vertebrae anomalies and a long-spanned kyphoscoliosis.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
本研究旨在评估杂交生长棒（GR）技术治疗先天性脊柱侧凸（CS）患儿的疗效。
背景资料概要
长节段后凸脊柱侧凸中先天性椎体异常很难通过确定性脊柱融合或标准 GR 技术来治疗。先前的研究提出了一期后路截骨短融合和 GR 撑开的杂交技术。然而，关于其疗效的数据很少。
方法
回顾性分析了 13 例接受杂交 GR 治疗的患儿（平均年龄 5.4±2.0 岁），其中 8 例接受单 GR 治疗，5 例接受双 GR 治疗。测量了所有的影像学数据，并记录了手术并发症。
结果
本队列平均进行了 4.1±1.7 次延长手术。在指数手术后，主弯从 86.4°±11.9°显著改善至 37.3°±12.4°（P<0.001）。术后整体后凸明显从 66.8°±16.1°减少至 33.3°±3.5°。随访期间，这些数值保持稳定。在冠状面畸形矫正方面，单 GR 和双 GR 两组之间没有显著差异，而单 GR 组的整体后凸矫正丢失明显高于双 GR 组（P=0.039）。指数手术后，T1-S1 平均增加 4.4±0.8cm，随访期间平均生长速度为 1.31±0.24cm/yr。两名患者（2 例）出现了 2 种并发症，包括 1 例棒断裂和 1 例近端交界性后凸。
结论
杂交 GR 技术在矫正脊柱畸形和允许脊柱持续生长方面是有效的。其最佳适应证为顶椎椎体畸形和长节段后凸脊柱侧凸的患儿。
证据等级
3 级。
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