Li Zihe, Zhou Feifei, Zhai Shuheng, Xia Tian, Pan Shengfa, Zhang Fengshan, Zhang Li, Chen Jiasheng, Sun Yu
Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
Engineering Research Center of Bone and Joint Precision Medicine, Ministry of Education, Beijing, China.
Orthop Surg. 2023 Oct;15(10):2709-2715. doi: 10.1111/os.13843. Epub 2023 Sep 7.
Single-center, retrospective study.
Hemivertebra resection is the only treatment option for congenital cervical scoliosis (CCS). However, this procedure is complex and technically demanding. It often requires a considerably long operation, and there is substantial intraoperative bleeding. Therefore, we have attempted to treat CCS with a concave side distraction comprising a three-dimensional (3D) printed titanium cage. The purpose of this study is to evaluate the safety and efficacy of this technique for the treatment of patients with CCS.
A series of 22 patients with CCS who underwent a concave side distraction technique between 2019 and 2021 were retrospectively reviewed and analyzed. Radiological measurements included the Cobb angle of the distraction segments, the kyphosis angle, the range of movement, and the distraction correction angle. Student's t-test and Spearman correlation analysis were used for statistical analysis. p < 0.05 was considered statistically significant.
The study included 12 males and 10 females whose ages ranged from 6 to 14 years old (9.8 ± 2.1 years old). Follow-up times ranged from 15 to 30 months (25.8 ± 3.6 months). Among 22 patients, two patients developed a postoperative C5 nerve root palsy and recovered after being treated with conservative treatment for 6 months. The duration of surgery ranged from 229 to 756 min (389 ± 112 min), and the estimated volume of blood loss ranged from 100 to 600mL (235 ± 121 mL). The coronal Cobb angle (p < 0.001), kyphosis angle (p < 0.05), and range of movement (p < 0.001) between the last follow-up and preoperative period were significantly different. A total of 28 segments were distracted, and the Cobb angle of the distraction segment ranged from 2.4 to 14.1° (8.5 ± 3.0°). There were six upper cervical spines (8.9 ± 1.9°) and 22 lower cervical spines (8.4 ± 3.2°) with no significant difference between them (p = 0.130). In addition, there was no correlation between the angle of the concave side distraction and patients' age (r = 0.018, p = 0.315). The fusion was solid between the bone and the customized 3D-printed pore metal cage at the final follow-up.
The concave side distraction comprising a customized 3D-printed titanium cage implantation can provide satisfactory correction results and is a safe and reliable procedure for treating CCS.
单中心回顾性研究。
半椎体切除术是先天性颈椎侧凸（CCS）的唯一治疗选择。然而，该手术复杂且技术要求高。它通常需要较长的手术时间，术中出血量大。因此，我们尝试使用包含三维（3D）打印钛笼的凹侧撑开术治疗CCS。本研究的目的是评估该技术治疗CCS患者的安全性和有效性。
回顾性分析2019年至2021年间接受凹侧撑开术的22例CCS患者。影像学测量包括撑开节段的Cobb角、后凸角、活动范围和撑开矫正角。采用Student's t检验和Spearman相关性分析进行统计学分析。p < 0.05被认为具有统计学意义。
该研究纳入12例男性和10例女性，年龄范围为6至14岁（9.8 ± 2.1岁）。随访时间为15至30个月（25.8 ± 3.6个月）。22例患者中，2例出现术后C5神经根麻痹，经6个月保守治疗后恢复。手术时间为229至756分钟（389 ± 112分钟），估计失血量为100至600mL（235 ± 121mL）。末次随访与术前相比，冠状面Cobb角（p < 0.001）、后凸角（p < 0.05）和活动范围（p < 0.001）有显著差异。共撑开28个节段，撑开节段的Cobb角为2.4至14.1°（8.5 ± 3.0°）。其中上颈椎6个节段（8.9 ± 1.9°），下颈椎22个节段（8.4 ± 3.2°），两者无显著差异（p = 0.130）。此外，凹侧撑开角度与患者年龄之间无相关性（r = 0.018，p = 0.315）。末次随访时，骨与定制的3D打印多孔金属笼之间融合牢固。
采用定制的3D打印钛笼植入的凹侧撑开术可提供满意的矫正效果，是治疗CCS安全可靠的手术方法。
