Bin Majid Ozair, Al-Zayed Zayed S, Alsultan Abdullah M, Altalhy Ali, Alsadoun Nouf F, Al-Mohrej Omar A
Department of Orthopaedic Surgery, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, CAN.
Cureus. 2021 Mar 29;13(3):e14167. doi: 10.7759/cureus.14167.
In congenital anomalies of the thoracic spine, fusion in situ and hemi-epiphysiodesis are unsuitable surgical options, because three-dimensional thoracic deformity and insufficiency are uncorrectable. We aimed to evaluate the radiological outcome of vertical expandable titanium rib (VEPTR) application after follow-up in children with congenital scoliosis with or without rib fusion.
In our study, we included 58 patients with congenital scoliosis with or without fused ribs; all treated with VEPTR from 2005 to 2015 at our institute. There were 19 males and 39 females. For each patient, we collected information about age at the index surgery (VEPTR application) and the total number of VEPTR lengthening procedures. Also, Cobb angle, kyphotic angle, thoracic height, and spinal height were measured on preoperative radiographs, immediately post-operative, two years post-operative, and at final follow-up.
The mean duration of follow-up was five years (range, 2-12 years). Twenty-eight patients had rib-to-pelvis type VEPTR, 20 patients had rib-to-rib type VEPTR, and 10 patients had a rib to pedicle/lamina type of VEPTR implant. Post-VEPTR, 63.8% of our patients reported one or more complications. The immediate post-VEPTR application showed that the mean Cobb angle decreased to 43.56° with a percentage change of 22.8% (p<0.001). The mean increase in thoracic height between VEPTR application surgery and final follow-up was 32 mm with a 19.3% increase (p<0.001). Similarly, the mean increase in the spinal height between the VEPTR application surgery and final follow-up was 46.6 mm, with a 23% increase (p<0.001).
VEPTR instrumentation for congenital scoliosis, with or without rib fusion, successfully corrects the coronal Cobb angle in the majority of patients. It also allows the thoracic (T1-T12) and spinal (T1-S1) growth to approach normal for a particular age.
在胸椎先天性畸形中，原位融合和半骨骺阻滞术是不合适的手术选择，因为三维胸廓畸形和功能不全无法得到纠正。我们旨在评估在先天性脊柱侧弯合并或不合并肋骨融合的儿童中，应用垂直可扩张钛肋骨（VEPTR）并进行随访后的影像学结果。
在我们的研究中，纳入了58例先天性脊柱侧弯合并或不合并肋骨融合的患者；所有患者均于2005年至2015年在我院接受VEPTR治疗。其中男性19例，女性39例。对于每位患者，我们收集了初次手术（应用VEPTR）时的年龄以及VEPTR延长手术的总次数等信息。此外，在术前X线片、术后即刻、术后两年以及末次随访时测量Cobb角、后凸角、胸廓高度和脊柱高度。
平均随访时间为5年（范围2 - 12年）。28例患者采用肋骨至骨盆型VEPTR，20例患者采用肋骨至肋骨型VEPTR，10例患者采用肋骨至椎弓根/椎板型VEPTR植入物。应用VEPTR后，63.8%的患者报告出现一种或多种并发症。VEPTR应用后即刻显示，平均Cobb角降至43.56°，变化百分比为22.8%（p<0.001）。从VEPTR应用手术到末次随访，胸廓高度平均增加32 mm，增幅为19.3%（p<０.001）。同样，从VEPTR应用手术到末次随访，脊柱高度平均增加46.6 mm，增幅为23%（p<0.001）。
对于先天性脊柱侧弯合并或不合并肋骨融合的患者，VEPTR器械植入术在大多数患者中成功矫正了冠状面Cobb角。它还使胸廓（T1 - T12）和脊柱（T1 - S1）的生长在特定年龄接近正常水平。
