Johnson Mitchell A, Cahill Patrick J, Qiu Catherine, Lott Carina, Mayer Oscar H, Flynn John M, Anari Jason B
Divison of Orthopaedic Surgery.
Division of Pulmonology, The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Orthop. 2020 Aug;40(7):344-350. doi: 10.1097/BPO.0000000000001514.
Severe early-onset scoliosis leads to deficient spine height, thoracic growth inhibition, and ultimately pulmonary compromise. Rib-based growing instrumentation seeks to correct thoracic deformities, in part by correcting the spinal deformity, adding height, increasing thoracic volume, and allowing for continual spinal growth until maturity. However, the amount of growth in these patients relative to their peers is unknown.
Sixty patients who had undergone surgical intervention for the treatment of early-onset scoliosis were assessed via radiographic measurements of coronal T1-S1 height and major curve angle before implantation and again at most recent follow-up (minimum 2 years). T1-S1 measurements were then compared with age-matched peers to assess growth differences. Clinical information was examined for relevant parameters.
The average age of our cohort at initial surgery and most recent follow-up was 4.4±3.8 and 10.0±4.4 years old, respectively. In this patient set, there was an average increase in T1-S1 height of 13.1±11.1 mm per year, with the majority of growth occurring in the first 2 years following implantation, and improvement in a major curve from 68±8 to 53±7 degrees. Overall, 77% of patients saw improvement in the major curve at most recent follow-up. Furthermore, a statistically significant greater percent of expected growth was seen in congenital compared with neuromuscular scoliosis (P<0.001). In addition, a weak negative correlation was observed between a number of surgical lengthenings and T1-S1 growth.
Rib-based implant intervention has been shown to improve the major curve, but only improves growth potential to around 80% of expected growth. Scoliosis diagnosis type also influences growth rate potential, with congenital scoliosis patients being surgically treated earlier in life and having a growth rate approaching that of a healthy individual.
Level III-Case control.
重度早发性脊柱侧弯会导致脊柱高度不足、胸廓生长受限，并最终影响肺部功能。基于肋骨的生长棒器械旨在矫正胸廓畸形，部分是通过矫正脊柱畸形、增加身高、扩大胸廓容积以及允许脊柱持续生长直至成熟。然而，这些患者相对于同龄人而言的生长量尚不清楚。
对60例接受手术治疗早发性脊柱侧弯的患者，在植入前及最近一次随访（至少2年）时通过影像学测量冠状面T1-S1高度和主弯角度进行评估。然后将T1-S1测量值与年龄匹配的同龄人进行比较，以评估生长差异。检查临床信息中的相关参数。
我们队列中初次手术和最近一次随访时的平均年龄分别为4.4±3.8岁和10.0±4.4岁。在这组患者中，T1-S1高度平均每年增加13.1±11.1毫米，大部分生长发生在植入后的前2年，主弯从68±8度改善至53±7度。总体而言，77%的患者在最近一次随访时主弯得到改善。此外，与神经肌肉型脊柱侧弯相比，先天性脊柱侧弯患者的预期生长百分比在统计学上显著更高（P<0.001）。此外，观察到手术延长次数与T1-S1生长之间存在微弱的负相关。
基于肋骨的植入物干预已被证明可改善主弯，但仅将生长潜力提高到预期生长的80%左右。脊柱侧弯的诊断类型也会影响生长速度潜力，先天性脊柱侧弯患者在生命早期接受手术治疗，其生长速度接近健康个体。
III级——病例对照研究。
