青少年特发性脊柱侧弯脊柱钉合术至骨骼成熟及以后的长期结果

Long-term Results of Spine Stapling for AIS to Skeletal Maturity and Beyond.

作者信息

Haber Lawrence L, Adams Tyler M, Briski David C, Celestre Paul C, Robbins Daniel J, Waldron Sean R

机构信息

Ochsner Hospital for Children, Ochsner Medical Center, New Orleans, LA.

University of Wisconsin School of Medicine and Public Health, Madison, WI.

出版信息

J Pediatr Orthop. 2020 Jan;40(1):e37-e41. doi: 10.1097/BPO.0000000000001389.

DOI:10.1097/BPO.0000000000001389

PMID:30973475

Abstract

BACKGROUND

We looked at long-term follow-up of spine stapling with Nitinol Staples. This was a cohort of all adolescent idiopathic scoliosis (AIS) patients with curves at high risk to progress based on curve magnitude, premenarchal status in all females, failure of brace treatment, and skeletal immaturity.

METHODS

This is a single surgeon retrospective review of consecutive AIS patients treated with Nitinol staples for progressive scoliosis. Fourteen patients, 16 curves from 2005 to 2008 were eligible. Minimum curve for stapling was 30 degrees. Standard preoperative, intraoperative, and postoperative data were collected. All patients were followed for a minimum of 36 months and to skeletal maturity. Three groups were: improved (group 1), correction of any amount; minimal progression (group 2), progression ≤10 degrees; and failure (group 3), ≥10 degrees of progression.

RESULTS

A total of 13 thoracic curves and 2 compensatory lumbar curves met the inclusion criteria (94%). Average follow-up was 61 months. The mean preoperative main thoracic curve was 35 degrees. All but 1 patients progressed at least 9 degrees in a brace prior to stapling. Females were all premenarchal, 10 patients were Risser 0 and 3 Risser 1. The average number of vertebrae stapled per curve was 6. Group 1 included 6 curves (40%). Group 2, 5 curves (33%). Group 3, 4 curves (27%). Three patients went on to uncomplicated fusion. Final curve measurement at the end of follow-up or before fusion (P=0.0037), curve progression (P≤0.001), and percentage of coronal correction on first postoperative standing radiograph (P=0.042) were the significant differences between groups 1+2 (successful) versus group 3 (failures). In total, 73% of this group either progressed ≤10 degrees or improved.

CONCLUSIONS

This is the first study that follows AIS patients treated with spine stapling to skeletal maturity. Staples likely changed natural history in some of our patients. Initial percentage of correction on first standing postoperative PA x-rays was the only predictor of success. Stapling was safe without any long-term complications.

LEVEL OF EVIDENCE

Level III-retrospective study.

摘要

背景

我们对使用镍钛合金钉进行脊柱钉合术的长期随访情况进行了研究。这是一组所有青少年特发性脊柱侧凸（AIS）患者，其侧弯基于侧弯程度、所有女性的初潮前状态、支具治疗失败以及骨骼未成熟等因素，有进展的高风险。

方法

这是对连续接受镍钛合金钉治疗进行性脊柱侧凸的AIS患者的单外科医生回顾性研究。2005年至2008年的14例患者、16个侧弯符合条件。钉合的最小侧弯度数为30度。收集了标准的术前、术中和术后数据。所有患者至少随访36个月直至骨骼成熟。分为三组：改善组（第1组），有任何程度的矫正；最小进展组（第2组），进展≤10度；失败组（第3组），进展≥10度。

结果

共有13个胸弯和2个代偿性腰弯符合纳入标准（94%）。平均随访61个月。术前主胸弯平均度数为35度。除1例患者外，所有患者在钉合前使用支具时至少进展了9度。女性均处于初潮前，10例患者Risser评分为0，3例为Risser 1。每个侧弯平均钉合的椎体数为6个。第1组包括6个侧弯（40%）。第2组，5个侧弯（33%）。第3组，4个侧弯（27%）。3例患者随后进行了无并发症的融合术。随访结束时或融合前的最终侧弯测量（P = 0.0037）、侧弯进展（P≤0.001）以及术后首次站立位X线片上的冠状面矫正百分比（P = 0.042）是第1 + 2组（成功）与第3组（失败）之间的显著差异。总体而言，该组73%的患者进展≤10度或有所改善。