San Diego Spine Foundation, San Diego.
Department of Orthopaedic Surgery, University of California San Diego School of Medicine, La Jolla.
J Pediatr Orthop. 2022 Jan 1;42(1):10-16. doi: 10.1097/BPO.0000000000001985.
It is unclear whether traditional growing rod (TGR) treatment outcomes vary by early-onset scoliosis (EOS) subtype. The goal of this study was to compare radiographic outcomes and complications of TGR treatment by EOS subtype.
We queried an international database of EOS patients from 20 centers to identify "graduates" who had (1) undergone primary TGR treatment from 1993 to 2014; (2) completed TGR treatment; and (3) had an uneventful clinical examination within 6 months after completion of TGR treatment with no anticipated further intervention. We included 202 patients in 4 etiologic subgroups: neuromuscular (n=65), syndromic (n=57), idiopathic (n=52), and congenital (n=28). Mean age at surgery was 7.1 years (range, 1.6 to 14.9 y); mean duration of follow-up was 8 years (range, 2 to 18.6 y). The groups did not differ by mean age, body mass index, sex, number of lengthenings, or duration of follow-up. The following preoperative differences were significant: (1) greater mean major curve in the neuromuscular versus idiopathic subgroup; (2) shorter spinal height (T1-S1) in the congenital versus idiopathic subgroup; and (3) smaller proportion of ambulatory patients in the neuromuscular subgroup versus all other subgroups.
We found no significant differences among subgroups in mean major curve correction or changes in thoracic height (T1-T12), spinal height, or global kyphosis at any point. Rates of deep surgical site infection, implant-related complications, and neurological complications were not different among subgroups. The medical complication rate was significantly lower in the idiopathic group compared with the other groups.
Major curve correction and spinal and thoracic height increases did not differ significantly at any point by EOS subtype. Rates of deep surgical site infection, implant-related complications, and neurological complications did not differ by subtype. Except for the lower rate of medical complications in the idiopathic group, our findings suggest that, after TGR treatment, patients can expect similar outcomes regardless of their EOS subtype.
Level III, therapeutic.
目前尚不清楚传统生长棒（TGR）治疗的结果是否因早发性脊柱侧凸（EOS）亚型而异。本研究的目的是比较 TGR 治疗不同 EOS 亚型的影像学结果和并发症。
我们从 20 个中心的 EOS 患者国际数据库中查询，以确定“毕业生”，他们（1）在 1993 年至 2014 年期间接受过原发性 TGR 治疗；（2）完成 TGR 治疗；（3）在 TGR 治疗完成后 6 个月内进行了无并发症的临床检查，预计无需进一步干预。我们纳入了 4 个病因亚组的 202 名患者：神经肌肉型（n=65）、综合征型（n=57）、特发性（n=52）和先天性（n=28）。手术时的平均年龄为 7.1 岁（范围，1.6 至 14.9 岁）；平均随访时间为 8 年（范围，2 至 18.6 岁）。各组在平均年龄、体重指数、性别、延长次数或随访时间上无差异。术前存在以下显著差异：（1）神经肌肉组的平均主要曲线大于特发性组；（2）先天性组的脊柱高度（T1-S1）短于特发性组；（3）神经肌肉组的活动患者比例小于其他所有亚组。
我们发现，在任何时间点，各组之间的平均主要曲线矫正或胸高（T1-T12）、脊柱高度或整体后凸的变化均无显著差异。各组之间深部手术部位感染、植入物相关并发症和神经并发症的发生率无差异。特发性组的医疗并发症发生率明显低于其他组。
在任何时间点，EOS 亚型的主要曲线矫正和脊柱及胸高增加均无显著差异。深部手术部位感染、植入物相关并发症和神经并发症的发生率与亚型无关。除特发性组的医疗并发症发生率较低外，我们的研究结果表明，接受 TGR 治疗后，患者可以预期无论其 EOS 亚型如何，都能获得相似的结果。
III 级，治疗性。
