Baky Fady J, Larson A Noelle, 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 Sep;7(5):836-841. doi: 10.1016/j.jspd.2019.01.004.
Retrospective review of prospective registries.
We hypothesized that patients with congenitally fused ribs who underwent thoracostomy upon implantation of rib-based distraction devices would achieve improved spine growth compared with those who did not undergo thoracostomy.
Patients with fused ribs may develop thoracic insufficiency syndrome. Treatment for severe early-onset spinal deformity with rib fusions often includes the placement of rib-based expansion devices with surgical division of the fused ribs (thoracostomy). The effect of thoracostomy on spinal growth has not been fully examined.
Two multicenter registries of primarily prospectively collected data were searched. Patients with fused ribs and implantation of a rib-based device were identified. A total of 151 patients with rib fusions treated with rib-based constructs and minimum two-year follow-up were included. Among those, 103 patients were treated with expansion thoracostomy at the time of implantation, whereas 48 patients received device implantation alone. We evaluated change in T1-T12 and T1-S1 height, coronal Cobb angle, kyphosis, and number of surgeries. Preoperative deformity was similar between the two groups. Only 19% of patient underwent final fusion, with similar numbers fused in each group.
At latest follow-up, the expansion thoracostomy group had a greater total improvement in T1-S1 height (7.2 cm vs. 4.8 cm, p = .004). There was no difference between the two groups for change in spinal height at each lengthening procedure. Interestingly, thoracostomy patients also underwent more total surgeries (11.5 vs. 9.6, p = .031) and more lengthening procedures (8.3 vs. 6.6, p = .017) than the comparison group despite similar length of follow-up.
Patients who underwent expansion thoracostomy at the time of rib expansion device implantation achieved greater improvement in T1-S1 height than those who underwent implantation of rib expansion device alone. Further work is needed to evaluate whether expansion thoracostomy impacts pulmonary function.
对前瞻性注册研究进行回顾性分析。
我们假设，与未接受胸廓切开术的患者相比，植入肋骨撑开装置时接受胸廓切开术的先天性肋骨融合患者脊柱生长情况会得到改善。
肋骨融合患者可能会发展为胸廓发育不全综合征。严重早发性脊柱畸形合并肋骨融合的治疗通常包括放置肋骨撑开装置并手术分离融合肋骨（胸廓切开术）。胸廓切开术对脊柱生长的影响尚未得到充分研究。
检索了两个主要前瞻性收集数据的多中心注册研究。确定了肋骨融合且植入肋骨装置的患者。纳入了总共151例接受肋骨融合治疗且随访至少两年的患者。其中，103例患者在植入时接受了扩张胸廓切开术，而48例患者仅接受了装置植入。我们评估了T1-T12和T1-S1高度、冠状面Cobb角、后凸畸形和手术次数的变化。两组术前畸形情况相似。仅19%的患者接受了最终融合，每组融合人数相似。
在最近一次随访时，扩张胸廓切开术组T1-S1高度的总体改善更大（7.2厘米对4.8厘米，p = 0.004）。两组在每次延长手术时脊柱高度的变化无差异。有趣的是，尽管随访时间相似，但胸廓切开术患者的总手术次数（11.5次对9.6次，p = 0.031）和延长手术次数（8.3次对6.6次，p = 0.017）也比对照组更多。
在植入肋骨撑开装置时接受扩张胸廓切开术的患者，其T1-S1高度的改善比仅接受肋骨撑开装置植入的患者更大。需要进一步研究来评估扩张胸廓切开术是否会影响肺功能。
