Miladi Lotfi, Solla Federico, Gaume Mathilde
Pediatric Orthopedic Surgery Department, Necker Hospital, Assistance Publique des Hopitaux de Paris (APHP), University of Paris-Cité, 75105 Paris, France.
Pediatric Orthopaedic Surgery, Lenval University Children's Hospital, 06200 Nice, France.
Children (Basel). 2024 Feb 9;11(2):228. doi: 10.3390/children11020228.
Growing rod techniques are increasingly used for early-onset scoliosis in children. Unfortunately, they are associated with many complications, particularly neuromuscular scoliosis, favored by the poor general condition of these patients and the fragility of their osteoporotic bones. Furthermore, these interventions are often iterative and usually followed by vertebral fusion at the end of growth. This is a review of the literature on a recent fusionless technique, minimally invasive bipolar fixation, which is more stable than the traditional growing rod techniques and less aggressive than vertebral arthrodesis. It allows the avoidance of arthrodesis, owing to the solidity of the construct and the stability of the results, leading to progressive spinal stiffening that occurs over time. The results of this technique have been published with a long follow-up period and have confirmed that it can completely replace posterior vertebral arthrodesis, especially in the most complicated scoliosis. Because it preserves growth, this technique should be recommended for early-onset scoliosis before the age of 10 years. The use of a self-expanding rod can avoid the need for repeated surgery, thereby reducing the risk of complications and the overall cost of treatment.
生长棒技术越来越多地用于儿童早发性脊柱侧弯。不幸的是，它们与许多并发症相关，尤其是神经肌肉型脊柱侧弯，这些患者的一般状况较差以及骨质疏松性骨骼的脆弱性助长了这种情况。此外，这些干预措施通常是反复进行的，并且通常在生长结束时进行椎体融合。本文是对一种近期的无融合技术——微创双极固定术的文献综述，该技术比传统的生长棒技术更稳定，且比椎体融合术的创伤性更小。由于该结构的坚固性和结果的稳定性，它避免了椎体融合，随着时间的推移会导致脊柱逐渐僵硬。这项技术的结果已在长期随访后发表，并证实它可以完全替代后路椎体融合术，尤其是在最复杂的脊柱侧弯病例中。由于它保留了生长能力，该技术应推荐用于10岁以下的早发性脊柱侧弯。使用自膨胀棒可以避免重复手术的需要，从而降低并发症风险和治疗的总体成本。
