Li Ye-Tian, Xu Lei-Lei, Xia Chao, Pan Wei, Sheng Fei, Qiu Yong, Zhu Ze-Zhang
Department of Spinal Surgery, Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, Jiangsu, China.
Zhongguo Gu Shang. 2020 Feb 25;33(2):116-20. doi: 10.12200/j.issn.1003-0034.2020.02.005.
To discuss the long-term outcome of convex epiphysiodesis in the treatment for congenital scoliosis (CS).
The clinical data of 22 patients with hemivertebral deformity undergoing convex epiphysiodesis from the October 1998 to Febuary 2008 were respectively analyzed. There were 12 males and 10 females. The whole spine anteroposterior radiographs were taken preoperatively, at 3-month postoperatively and at the final follow-up to measure the main curve and the compensatory curve. The progression rate was calculated for each patient. Observing the correlation between the progression rate and annual progression of the scoliosis and age, gender, hemivertebral number, hemivertebral position, preoperative main curve Cobb angle and compensatory curve Cobb angle, comparing different ages, genders, hemivertebral number and position, and preoperative main curve Cobb angle on the progression of postoperative curve.
The mean Cobb angle of main curve changed from (40.5±9.8) ° before surgery to (39.5±11.1) ° at 3 months after surgery, which significantly increased to (46.8±13.9) ° in the final follow-up. Meanwhile the mean Cobb angle of compensatory curve was changed from (20.1±10.8) ° before surgery to (23.0±11.1) °, which significantly increased to (29.9±11.5) ° in the final follow-up. There were no significant differences in the Cobb angle of the main curve and the compensatory curve between postoperative 3 months and before operation (>0.05). The difference between the final follow-up and the preoperative, postoperative 3 months was statistically significant (<0.01). Twenty patients experienced progression of both main curve and compensatory curve, with a mean progression rate of (19.2±17.9)% for main curve and (39.6±37.0)% for compensatory curve. The annual progression volume was (1.5± 1.4) ° for main curve and (1.4±1.3) ° for compensatory curve. Three patients underwent lateral convex orthopedic internal fixation due to postoperative scoliosis progression. The curve progression was significantly correlated with age at the time of surgery and hemivertebral number. There was a significant correlation between the age of the operation, the main curve angle, the preoperative compensatory curve angle and the annual progression volume of the main curve (<0.05).
The convex epiphysiodesis technique cannot effectively prevent curve progression of CS patients in the long-term follow-up. It is not recommended to apply this technique to the treatment of patients with congenital hemivertebrae.
探讨凸侧骨骺阻滞术治疗先天性脊柱侧凸（CS）的远期疗效。
回顾性分析1998年10月至2008年2月行凸侧骨骺阻滞术治疗的22例半椎体畸形患者的临床资料。其中男12例，女10例。分别于术前、术后3个月及末次随访时拍摄全脊柱正位X线片，测量主弯及代偿弯角度，计算每位患者的进展率。观察进展率与脊柱侧凸年进展量、年龄、性别、半椎体数量、半椎体位置、术前主弯Cobb角及代偿弯Cobb角的相关性，比较不同年龄、性别、半椎体数量及位置、术前主弯Cobb角对术后曲线进展的影响。
主弯平均Cobb角由术前的（40.5±9.8）°变为术后3个月的（39.5±11.1）°，末次随访时显著增大至（46.8±13.9）°。同时，代偿弯平均Cobb角由术前的（20.1±10.8）°变为术后3个月的（23.0±11.1）°，末次随访时显著增大至（29.9±11.5）°。术后3个月主弯和代偿弯Cobb角与术前比较差异无统计学意义（>0.05）。末次随访与术前、术后3个月比较差异有统计学意义（<0.01）。20例患者主弯和代偿弯均有进展，主弯平均进展率为（19.2±17.9）%，代偿弯平均进展率为（39.6±37.0）%。主弯年进展量为（1.5±1.4）°，代偿弯年进展量为（1.4±1.3）°。3例患者因术后脊柱侧凸进展行侧凸矫形内固定术。曲线进展与手术时年龄及半椎体数量显著相关。手术年龄、主弯角度、术前代偿弯角度与主弯年进展量之间存在显著相关性（<0.05）。
在长期随访中，凸侧骨骺阻滞术不能有效防止CS患者曲线进展。不建议将该技术应用于先天性半椎体患者的治疗。
