椎体束带断裂后会发生什么？五年随访的发生率、位置及进展情况。
What Happens After a Vertebral Body Tether Break? Incidence, Location, and Progression With Five-year Follow-up.
作者信息
Yang Michael J, Samdani Amer F, Pahys Joshua M, Quinonez Alejandro, McGarry Maureen, Grewal Harsh, Hwang Steven W
机构信息
Shriners Children's-Philadelphia, Philadelphia, PA.
Tufts Medical Center, Boston, MA.
出版信息
Spine (Phila Pa 1976). 2023 Jun 1;48(11):742-747. doi: 10.1097/BRS.0000000000004665. Epub 2023 Apr 5.
STUDY DESIGN
Retrospective review.
OBJECTIVE
To study risk factors for anterior vertebral body tether (VBT) breakage.
SUMMARY OF BACKGROUND DATA
VBT is used to treat adolescent idiopathic scoliosis in skeletally immature patients. However, tethers break in up to 48% of cases.
MATERIALS AND METHODS
We reviewed 63 patients who underwent thoracic and/or lumbar VBT with a minimum five-year follow-up. We radiographically characterized suspected tether breaks as a change in interscrew angle >5°. Demographic, radiographic, and clinical risk factors for presumed VBT breaks were evaluated.
RESULTS
In confirmed VBT breaks, the average interscrew angle change was 8.1°, and segmental coronal curve change was 13.6°, with a high correlation ( r =0.82). Our presumed VBT break cohort constituted 50 thoracic tethers, four lumbar tethers, and nine combined thoracic/lumbar tethers; the average age was 12.1±1.2 years and the mean follow-up was 73.1±11.7 months. Of 59 patients with thoracic VBTs, 12 patients (20.3%) had a total of 18 breaks. Eleven thoracic breaks (61.1%) occurred between two and five years postoperatively, and 15 (83.3%) occurred below the curve apex ( P <0.05). The timing of thoracic VBT breakage moderately correlated with more distal breaks ( r =0.35). Of 13 patients who underwent lumbar VBT, eight patients (61.5%) had a total of 12 presumed breaks. Six lumbar breaks (50%) occurred between one and two years postoperatively, and seven (58.3%) occurred at or distal to the apex. Age, sex, body mass index, Risser score, and curve flexibility were not associated with VBT breaks, but the association between percent curve correction and thoracic VBT breakage trended toward significance ( P =0.054). Lumbar VBTs were more likely to break than thoracic VBTs ( P =0.016). Seven of the patients with presumed VBT breaks (35%) underwent revision surgery.
CONCLUSIONS
Lumbar VBTs broke with greater frequency than thoracic VBTs, and VBT breaks typically occurred at levels distal to the curve apex. Only 15% of all patients required revision.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
研究椎体前路栓系术（VBT）断裂的危险因素。
背景数据总结
VBT用于治疗骨骼未成熟患者的青少年特发性脊柱侧凸。然而，栓系断裂的发生率高达48%。
材料与方法
我们回顾了63例行胸段和/或腰段VBT且随访至少5年的患者。我们将疑似栓系断裂在影像学上的特征定义为螺钉间角度变化>5°。评估了假定的VBT断裂的人口统计学、影像学和临床危险因素。
结果
在确诊的VBT断裂中，螺钉间平均角度变化为8.1°，节段性冠状面弯曲变化为13.6°，两者具有高度相关性（r = 0.82）。我们假定的VBT断裂队列包括50根胸段栓系、4根腰段栓系和9根胸腰段联合栓系；平均年龄为12.1±1.2岁，平均随访时间为73.1±11.7个月。在59例行胸段VBT的患者中，12例患者（20.3%）共发生18次断裂。11次胸段断裂（61.1%）发生在术后2至5年，15次（83.3%）发生在弯曲顶点以下（P <0.05）。胸段VBT断裂的时间与更远处的断裂有中度相关性（r = 0.35）。在13例行腰段VBT的患者中，8例患者（61.5%）共发生12次假定断裂。6次腰段断裂（50%）发生在术后1至2年，7次（58.3%）发生在顶点或顶点远端。年龄、性别、体重指数、Risser评分和弯曲柔韧性与VBT断裂无关，但弯曲矫正百分比与胸段VBT断裂之间的关联有显著趋势（P = 0.054）。腰段VBT比胸段VBT更容易断裂（P = 0.016）。7例假定VBT断裂的患者（35%）接受了翻修手术。
结论
腰段VBT比胸段VBT断裂频率更高，且VBT断裂通常发生在弯曲顶点远端水平。所有患者中只有15%需要翻修。
证据级别
3级。
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