Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland.
Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
J Bone Joint Surg Am. 2022 Jan 5;104(1):41-48. doi: 10.2106/JBJS.20.02108.
Severe early-onset scoliosis (EOS) is managed surgically but represents a challenge due to limited implant fixation points, large curve size, and fragile patients with comorbidities. Magnetically controlled growing rods (MCGRs) have the advantage of avoiding surgical intervention for routine lengthening, but their ability to address severe EOS has not been studied, to our knowledge.
A retrospective review of a prospectively collected international database identified 44 children with severe (≥90°) EOS treated with MCGRs who met our study criteria. Etiology, age, and sex-matched patients treated with traditional growing rods (TGRs) were identified from the same database. Patients were evaluated at a 2-year follow-up. No patients with vertically expandable prosthetic titanium ribs (VEPTRs) were included. The health-related quality of life was evaluated with the 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24).
The mean preoperative major coronal curve was 104° in the MCGR group and 104° in the TGR group. At the 2-year follow-up, the mean major coronal curves were 52° and 66° (p = 0.001), respectively. The mean T1-T12 heights were 155 mm and 152 mm preoperatively and 202 mm and 192 mm at the 2-year follow-up (p = 0.088). According to Kaplan-Meier analysis, the 2-year unplanned-revision-free survival was 91% in the MCGR group and 71% in the TGR group (p < 0.005). The 2-year score in the EOSQ-24 pulmonary function domain was better in the MCGR group. There were no other significant differences in the EOSQ-24 scores between the groups.
MCGRs for severe EOS provided significantly better major curve correction with significantly fewer unplanned revisions than TGRs at a 2-year follow-up.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
严重早发性脊柱侧凸（EOS）需要手术治疗，但由于植入物固定点有限、曲线较大且患者合并症多，因此具有挑战性。磁控生长棒（MCGR）的优势在于避免了常规延长的手术干预，但据我们所知，其治疗严重 EOS 的能力尚未得到研究。
对一个前瞻性收集的国际数据库进行回顾性分析，确定了 44 名患有严重（≥90°）EOS 的患儿，他们接受了 MCGR 治疗，符合我们的研究标准。从同一数据库中确定了患有传统生长棒（TGR）的病因、年龄和性别匹配的患者。对患者进行了 2 年的随访。不包括垂直可扩展假体钛肋骨（VEPTR）患者。使用 24 项早发性脊柱侧凸问卷（EOSQ-24）评估健康相关生活质量。
MCGR 组术前主要冠状面曲线平均为 104°，TGR 组为 104°。在 2 年随访时，主要冠状面曲线分别为 52°和 66°（p = 0.001）。术前 T1-T12 高度分别为 155mm 和 152mm，2 年随访时为 202mm 和 192mm（p = 0.088）。根据 Kaplan-Meier 分析，MCGR 组 2 年无计划翻修率为 91%，TGR 组为 71%（p < 0.005）。MCGR 组在 EOSQ-24 肺功能域的 2 年评分更好。两组在 EOSQ-24 评分上没有其他显著差异。
与 TGR 相比，MCGR 治疗严重 EOS 在 2 年随访时提供了更好的主要曲线矫正效果，无计划翻修率显著降低。
治疗性 III 级。欲了解完整的证据水平描述，请参阅作者说明。
