Qiu Catherine, Lott Carina, Agaba Perez, Cahill Patrick J, Anari Jason B
Division of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, PA.
J Pediatr Orthop. 2020 Sep;40(8):e747-e752. doi: 10.1097/BPO.0000000000001625.
Severe early-onset scoliosis (EOS) has been associated with a multitude of comorbidities, chief among them being deficient thoracic spine growth and pulmonary complications. EOS management with rib-based instrumentation involves repeated lengthening. Despite expansion practice patterns, there is limited literature and no evidence-based guidelines for optimal expansion intervals. Our study evaluates clinical outcomes in relation to lengthening intervals with the aim of optimizing the timing of surgical expansion in EOS patients.
A single-institution retrospective review of 60 EOS patients treated with rib-based growth instrumentation with a minimum of 3-year follow-up and 3 expansion/revision surgeries. Patients were separated into 2 expansion cohorts: (1) more frequent lengthening [MFL group (≤7 mo)] and (2) less frequent lengthening [LFL group (>7 mo)]. Demographic information and clinical factors were recorded. Univariate and bivariate analyses were performed.
Both the MFL group (35 patients) and LFL group (25 patients) were similar in sex distribution, diagnosis, preoperative parameters of interest, and treatment duration. The mean follow-up was 6.0 years. There was an increase in postoperative T1-S1 spine height gained in the MFL group (P=0.006) as well as a higher percent expected spine growth based on normative values (P=0.03) when compared with the LFL group. The MFL group had more expansion/revision surgeries (P=0.003) but no increase in the number of complications (P=0.86).
More frequent lengthenings were associated with statistically significant overall spinal height gain and percent expected growth without a significant increase in complication rates. It was shown that change in major curve and space available for the lungs was not associated with the lengthening intervals.
Level III-a comparative retrospective study.
重度早发性脊柱侧凸（EOS）与多种合并症相关，其中最主要的是胸椎生长不足和肺部并发症。基于肋骨的器械治疗EOS需要反复延长。尽管临床实践模式有所扩展，但关于最佳延长间隔的文献有限且缺乏循证指南。我们的研究评估了与延长间隔相关的临床结果，旨在优化EOS患者手术延长的时机。
对60例接受基于肋骨生长器械治疗的EOS患者进行单机构回顾性研究，随访至少3年且进行了3次延长/翻修手术。患者分为2个延长队列：（1）更频繁延长[MFL组（≤7个月）]和（2）较不频繁延长[LFL组（>7个月）]。记录人口统计学信息和临床因素。进行单因素和双因素分析。
MFL组（35例患者）和LFL组（25例患者）在性别分布、诊断、术前相关参数和治疗持续时间方面相似。平均随访时间为6.0年。与LFL组相比，MFL组术后T1-S1脊柱高度增加（P = 0.006），基于标准值的预期脊柱生长百分比更高（P = 0.03）。MFL组有更多的延长/翻修手术（P = 0.003），但并发症数量没有增加（P = 0.86）。
更频繁的延长与统计学上显著的总体脊柱高度增加和预期生长百分比相关，且并发症发生率没有显著增加。结果表明，主弯变化和肺部可用空间与延长间隔无关。
III-a级比较性回顾性研究。
