Department of Orthopaedics, Johns Hopkins University, Baltimore, MD.
Department of Orthopaedics, Seattle Children's Hospital, Seattle, WA.
J Pediatr Orthop. 2022 Feb 1;42(2):e188-e191. doi: 10.1097/BPO.0000000000002003.
Multicenter retrospective study.
Recent studies have demonstrated diminishing returns in patients with early onset scoliosis (EOS) undergoing repeated lengthening of growing rods. Little is known about whether this same phenomenon occurs in patients with lax connective tissue disease (CTD). The primary purpose of this study is to investigate whether EOS patients with connective tissue laxity disorders have diminishing returns during growth friendly surgery.
CTD EOS patients below 10 years old, underwent growth friendly spine surgery with distal anchors and at least 1 proximal spine anchor, and had minimum follow-up of 5 years were included in this study. Coronal T1-S1 height at preindex surgery, postindex, and every available lengthening was assessed. Mean coronal height change during early set distractions and late set distractions were calculated for the cohort. To account for varying distraction intervals, we normalized the distractions by the time interval. The outcome parameter was T1-S1 height gain, mm/year.
Twenty-one CTD patients were included in this study. Total coronal height (T1-S1) was 26.7MHCcm before index, 32.2 cm at D1-D3, 34.7 cm at D4-D6, and 36.7 cm at D7-L10. There were no significant differences in coronal height gains between early and late distractions (P=0.70). Moreover, when normalized for time, there was no significant difference in net gain per year at different lengthening time points for the CTD group, P=0.59.
There is no evidence of diminishing returns in coronal T1-S1 height gain in patients with EOS in the setting of CTD.
Level III.
多中心回顾性研究。
最近的研究表明，早期发病脊柱侧凸（EOS）患者在接受多次生长棒延长后，收益递减。对于结缔组织疾病（CTD）患者是否也存在同样的现象，知之甚少。本研究的主要目的是探讨结缔组织松弛的 EOS 患者在进行友好型生长手术时是否存在收益递减。
本研究纳入了年龄在 10 岁以下、接受过生长友好型脊柱手术（带有远端锚定和至少 1 个近端脊柱锚定）的 CTD EOS 患者，且随访时间至少 5 年。评估术前、术后及每次可测量延长时的冠状位 T1-S1 高度。计算了该队列中早期和晚期设置分散时的平均冠状高度变化。为了考虑到不同的分散间隔，我们通过时间间隔对分散进行了归一化。该研究的结果参数为 T1-S1 高度增加量，mm/年。
本研究共纳入了 21 例 CTD 患者。指数前总冠状高度（T1-S1）为 26.7MHCcm，D1-D3 时为 32.2cm，D4-D6 时为 34.7cm，D7-L10 时为 36.7cm。早期和晚期分散时的冠状高度增加量无显著差异（P=0.70）。此外，当按时间归一化时，CTD 组在不同延长时间点的净年增长率没有显著差异，P=0.59。
在 CTD 背景下，EOS 患者的冠状 T1-S1 高度增加不存在收益递减的证据。
III 级。
