Murray Erin, Tung Robert, Sherman Ashley, Schwend Richard M
University of Missouri-Kansas City, 5100 Rockhill Rd, Kansas City, MO, 64110, USA.
University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
Spine Deform. 2020 Apr;8(2):221-226. doi: 10.1007/s43390-019-00019-x. Epub 2020 Feb 5.
Retrospective case series.
To quantitatively measure the rate of growth of vertebral bodies in juvenile idiopathic scoliosis (JIS) treated with vertebral body stapling (VBS). VBS has been suggested to be a safe and effective method for modulating the growth of the young scoliotic spine, but few long-term studies have examined its efficacy.
Seven patients with JIS 11 years of age or younger underwent VBS with a minimum 6-year follow-up. Vertebral body height on the unstapled and stapled aspects of the curve was measured from initial and final postoperative radiographs and converted into rate of growth per year. Known staple dimensions were used to standardize the measurements between radiographs. Interstaple distance was measured to demonstrate continued growth of the spine. Adjacent vertebral bodies without instrumentation served as an internal control of growth. Each vertebral body (n = 35) was analyzed as an individual experimental unit.
The average rate of growth was 0.86 mm/year (standard deviation [SD] 0.44, 95% confidence interval [CI] 0.71-1.0) per vertebral body on the stapled side and 0.83 mm/year (SD 0.46, 95% CI 0.67-0.98) per vertebral body on the unstapled side of the vertebral body. The adjacent vertebral body segments grew at a rate of 0.91 mm/year (SD 0.42, 95% CI 0.66-1.15) on the stapled side and 0.99 mm/year (SD 0.66, 95% CI 0.61-1.37) on the unstapled side, p < 0.01. The distance between staples increased significantly from 3.0 mm (SD 2.0, 95% CI 2.3-3.6) to 8.4 mm (SD 2.4, 95% CI 7.7-9.3).
Vertebral body growth in the presence of VBS occurred at a similar rate on the stapled and unstapled sides of the curve. The high standard deviation of instrumented segment growth further supports the conclusion that VBS is not a reliable method of growth modulation in the young scoliotic spine.
IV.
回顾性病例系列研究。
定量测量椎体钉合术（VBS）治疗的青少年特发性脊柱侧凸（JIS）患者椎体的生长速率。有人提出VBS是调节青少年脊柱侧凸患者脊柱生长的一种安全有效的方法，但很少有长期研究检验其疗效。
7例11岁及以下的JIS患者接受了VBS治疗，并进行了至少6年的随访。从术后初始和最终X线片测量侧弯未钉合侧和钉合侧的椎体高度，并换算为每年的生长速率。使用已知的钉的尺寸来标准化X线片之间的测量。测量钉间距以证明脊柱的持续生长。未进行器械固定的相邻椎体作为生长的内部对照。每个椎体（n = 35）作为一个单独的实验单位进行分析。
钉合侧每个椎体的平均生长速率为0.86毫米/年（标准差[SD] 0.44，95%置信区间[CI] 0.71 - 1.0），椎体未钉合侧每个椎体的平均生长速率为0.83毫米/年（SD 0.46，95% CI 0.67 - 0.98）。相邻椎体节段在钉合侧的生长速率为0.91毫米/年（SD 0.42，95% CI 0.66 - 1.15），在未钉合侧的生长速率为0.99毫米/年（SD 0.66，95% CI 0.61 - 1.37），p < 0.01。钉间距从3.0毫米（SD 2.0，95% CI 2.3 - 3.6）显著增加到8.4毫米（SD 2.4，95% CI 7.7 - 9.3）。
在VBS存在的情况下，侧弯钉合侧和未钉合侧的椎体生长速率相似。器械固定节段生长的高标准差进一步支持了VBS不是调节青少年脊柱侧凸患者脊柱生长的可靠方法这一结论。
IV级。
