Wang Shengru, Zhao Yiwei, Yang Yang, Lin Guanfeng, Shen Jianxiong, Zhao Yu, Wu Nan, Zhuang Qianyu, Du You, Zhang Jianguo
J Neurosurg Spine. 2022 Oct 7;38(2):199-207. doi: 10.3171/2022.8.SPINE22618. Print 2023 Feb 1.
The authors' objective was to compare the intermediate outcomes of patients with severe congenital early-onset scoliosis (CEOS) treated with posterior vertebrectomy/hemivertebrectomy with short fusion and dual growing rods (hybrid technique [HT]) and those treated with traditional dual growing rods (TDGRs).
A retrospective study of patients who underwent the HT and TDGR technique for CEOS was conducted. The inclusion criteria were CEOS (age < 10 years), Risser stage 0, treatment with HT or TDGR, index surgery performed between 2004 and 2017, and minimum follow-up of 3 years. For patients who completed lengthening procedures, the last lengthening procedure was considered the latest follow-up. Demographic, radiographic, clinical, and patient-reported outcomes and revisions were compared between groups.
Sixty-one patients with CEOS were included in this study, with 16 treated with HT and 45 with TDGR technique. There were no differences in age at index surgery, duration of treatment, or number of lengthening procedures. The lengthening interval was longer in the HT group. The preoperative mean ± SD main curve was 81.8° ± 17.1° for the HT group and 63.3° ± 16.9° for the TDGR group (p < 0.05). However, main curve correction was better in the HT group, and no differences in residual curve were found between groups. Although the preoperative apex vertebral translation (AVT) of the HT group was greater, the correction of AVT was better in the HT group (p < 0.05). No differences in T1-S1 and T1-12 height were found between groups at the latest follow-up. The growth of T1-S1 height was less in the HT group (p < 0.05), whereas the growth of T1-12 height was similar between groups. Patients in the HT group had a lower risk of mechanical complications but higher risks of dural tears and neurological complications.
HT may provide better correction and apex control ability than TDGR for EOS patients with severe and rigid deformity at the apex level, and it significantly decreased the risk of mechanical complications with little influence on growth of the thoracic spine. HT may be an option for patients with severe CEOS with large asymmetrical growth potential around the apex of the curve.
作者的目的是比较采用后路椎体切除术/半椎体切除术加短节段融合及双生长棒（混合技术[HT]）治疗的重度先天性早发性脊柱侧凸（CEOS）患者与采用传统双生长棒（TDGRs）治疗的患者的中期疗效。
对接受HT和TDGR技术治疗CEOS的患者进行回顾性研究。纳入标准为CEOS（年龄<10岁）、Risser 0期、采用HT或TDGR治疗、2004年至2017年间进行首次手术且最短随访3年。对于完成延长手术的患者，将最后一次延长手术视为最新随访。比较两组患者的人口统计学、影像学、临床、患者报告的结局及翻修情况。
本研究纳入61例CEOS患者，其中16例采用HT治疗，45例采用TDGR技术治疗。首次手术时的年龄、治疗时间或延长手术次数无差异。HT组的延长间隔更长。HT组术前主弯平均±标准差为81.8°±17.1°，TDGR组为63.3°±16.9°（p<0.05）。然而，HT组的主弯矫正效果更好，且两组间残留弯度无差异。尽管HT组术前顶椎平移（AVT）更大，但HT组的AVT矫正效果更好（p<0.05）。在最新随访时，两组间T1-S1和T1-12高度无差异。HT组T1-S1高度的增长较少（p<0.05），而两组间T1-12高度的增长相似。HT组患者发生机械并发症的风险较低，但发生硬脊膜撕裂和神经并发症的风险较高。
对于顶椎水平存在严重僵硬畸形的EOS患者，HT可能比TDGR提供更好的矫正和顶椎控制能力，并且能显著降低机械并发症的风险，对胸椎生长影响较小。对于曲线顶椎周围具有较大不对称生长潜能的重度CEOS患者，HT可能是一种选择。
