Bachabi Malick, McClung Anna, Pawelek Jeff B, El Hawary Ron, Thompson George H, Smith John T, Vitale Michael G, Akbarnia Behrooz A, Sponseller Paul D
Division of Pediatric Orthopaedic Surgery.
Growing Spine Foundation.
J Pediatr Orthop. 2020 Mar;40(3):142-148. doi: 10.1097/BPO.0000000000001202.
Distraction-based techniques allow spinal growth until skeletal maturity while preventing curve progression.
Two multicenter early-onset scoliosis databases were used to identify patients with idiopathic spine abnormalities treated with traditional growing rods (TGR) or vertically expandable titanium ribs (VEPTR). Patients underwent at least 4 lengthenings and had at least 5-year follow-up. Significance was set at P<0.05.
In total, 50 patients treated with TGR and 22 treated with VEPTR were included. Mean (±SD) age at surgery was 5.5 (±2.0) years for the TGR group versus 4.3 (±1.9) years for the VEPTR group (P=0.044); other demographic parameters were similar. VEPTR patients had more procedures (mean 15±4.2) than TGR patients (mean 10±4.0) (P=0.001). Unilateral constructs were present in 18% (4 of 22) of VEPTR and 16% (8 of 50) of TGR patients. Bilateral constructs spanned a mean 2.1 additional surgical levels and exposed patients to 1.6 fewer procedures than unilateral constructs. Curve correction was similar between bilateral and unilateral constructs. TGR patients experienced greater curve correction (50%) than VEPTR patients (27%) (P<0.001) and achieved a greater percentage of thoracic height gain (24%) than VEPTR patients (12%) (P=0.024). At latest follow-up, TGR patients had better maintenance of curve correction, less kyphosis, and 15% greater absolute gain in thoracic height versus VEPTR patients. TGR patients had a lower rate of wound complications (14%) than VEPTR patients (41%) (P=0.011).
In patients with idiopathic early-onset scoliosis, TGRs produced greater initial curve correction, greater thoracic height gains, less kyphosis, and lower incidence of wound complications compared with VEPTR.
Level III.
基于撑开的技术可使脊柱在骨骼成熟前实现生长，同时防止侧弯进展。
利用两个多中心早发性脊柱侧弯数据库，确定接受传统生长棒（TGR）或垂直可扩展钛肋骨（VEPTR）治疗的特发性脊柱异常患者。患者至少接受了4次延长手术，并至少有5年的随访。显著性设定为P<0.05。
总共纳入了50例接受TGR治疗的患者和22例接受VEPTR治疗的患者。TGR组手术时的平均（±标准差）年龄为5.5（±2.0）岁，而VEPTR组为4.3（±1.9）岁（P=0.044）；其他人口统计学参数相似。VEPTR患者的手术次数（平均15±4.2次）多于TGR患者（平均10±4.0次）（P=0.001）。18%（22例中的4例）的VEPTR患者和16%（50例中的8例）的TGR患者采用单侧固定。双侧固定平均多跨越2.1个手术节段，与单侧固定相比，患者接受的手术次数少1.6次。双侧和单侧固定的侧弯矫正效果相似。TGR患者的侧弯矫正效果（50%）优于VEPTR患者（27%）（P<0.001），胸段高度增加的百分比（24%）高于VEPTR患者（12%）（P=0.024）。在最近一次随访时，与VEPTR患者相比，TGR患者的侧弯矫正维持得更好，后凸畸形更小，胸段高度的绝对增加量高15%。TGR患者的伤口并发症发生率（14%）低于VEPTR患者（41%）（P=0.011）。
在特发性早发性脊柱侧弯患者中，与VEPTR相比，TGR能产生更大的初始侧弯矫正效果、更大的胸段高度增加、更小的后凸畸形以及更低的伤口并发症发生率。
三级。
