El-Hawary Ron, Chukwunyerenwa Chukwudi K, Gauthier Luke E, Spurway Alan J, Hilaire Tricia St, McClung Anna M, El-Bromboly Yehia, Johnston Charles E
IWK Health Centre, Halifax, NS, B3K-6R8, Canada.
Pediatric Spine Study Group, P.O. Box 397, Valley Forge, PA, USA.
Spine Deform. 2020 Apr;8(2):303-309. doi: 10.1007/s43390-019-00025-z. Epub 2020 Feb 5.
Retrospective, comparative, multicenter.
To determine if the choice of proximal anchor affects thoracic sagittal spine length (SSL) for children with idiopathic early-onset scoliosis (EOS). Debate exists as to whether spine growth is maintained during treatment for EOS. As rib- (RB) and spine-based (SB) distraction procedures may be kyphogenic, the traditional measurement of spine growth on coronal radiographs may not identify out-of-plane increase in spine length. A measure of SSL, along the spine's sagittal arc of curvature, has been validated to reliably assess the length of the thoracic spine.
Patients with idiopathic EOS treated with distraction-based systems (minimum 5-year follow-up, five lengthening surgeries) with radiographic analysis preoperatively, postimplant (L1), and during lengthening periods (L2-L5, L6-L10) were evaluated with primary outcome of T1-T12 SSL.
We identified 34 patients (14 RB, 20 SB) with preoperative age 4.9 years (4.2 RB vs. 5.4 SB), scoliosis 72° (60° RB vs. 77° SB; p < 0.05), kyphosis 39° (50° RB vs. 34° SB; p < 0.05), and SSL 17.8 cm (15.5 RB vs. 18.5 SB; p < 0.05). After initial scoliosis correction from implantation, scoliosis remained constant over time. RB patients had greater kyphosis than SB patients: L1, 46° RB vs. 19° SB (p < 0.05); L2-L5, 50° RB vs. 27° SB (p < 0.05); L6-L10, 56° RB vs. 26° SB (p < 0.05). SSL increased for both groups from preoperative to the tenth lengthening (p < 0.05). As compared with RB patients, SB patients had higher SSL preoperatively and maintained this difference to the tenth lengthening (p < 0.05). After ten lengthening surgeries, when normalized to preoperative SSL, relative thoracic growth was greater for RB (27%) than for SB patients (19%) (p < 0.05).
Regardless of proximal anchor choice, thoracic length continued to increase during the distraction phase of treatment for idiopathic EOS.
Level III.
回顾性、对比性、多中心研究。
确定对于特发性早发性脊柱侧弯（EOS）患儿，近端锚定物的选择是否会影响胸段矢状脊柱长度（SSL）。关于EOS治疗期间脊柱生长是否得以维持存在争议。由于基于肋骨（RB）和基于脊柱（SB）的撑开手术可能会导致后凸，传统的在冠状位X线片上测量脊柱生长可能无法识别脊柱长度在平面外的增加。沿脊柱矢状弯曲弧测量的SSL已被证实可可靠地评估胸椎长度。
对接受基于撑开系统治疗的特发性EOS患者（至少5年随访，5次延长手术）进行术前、植入后（L1）以及延长期间（L2 - L5，L6 - L10）的影像学分析，以T1 - T12 SSL作为主要结局指标进行评估。
我们确定了34例患者（14例RB，20例SB），术前年龄4.9岁（RB组4.2岁 vs. SB组5.4岁），脊柱侧弯72°（RB组60° vs. SB组77°；p < 0.05），后凸39°（RB组50° vs. SB组34°；p < 0.05），SSL为17.8 cm（RB组15.5 cm vs. SB组18.5 cm；p < 0.05）。植入后最初矫正脊柱侧弯后，脊柱侧弯随时间保持稳定。RB组患者的后凸大于SB组患者：L1时，RB组46° vs. SB组19°（p < 0.05）；L2 - L5时，RB组50° vs. SB组27°（p < 0.05）；L6 - L10时，RB组56° vs. SB组26°（p < 0.05）。两组的SSL从术前到第10次延长时均增加（p < 0.05）。与RB组患者相比，SB组患者术前的SSL更高，且这种差异一直维持到第10次延长（p < 0.05）。在进行10次延长手术后，以术前SSL进行标准化后，RB组（27%）的相对胸段生长大于SB组患者（19%）（p < 0.05）。
对于特发性EOS，无论近端锚定物如何选择，在治疗的撑开阶段胸段长度持续增加。
三级。
