Tetreault Tyler A, Phan Tiffany N, Wren Tishya A L, Heffernan Michael J, Emans John B, Karlin Lawrence I, Samdani Amer F, Helenius Ilkka J, Vitale Michael G, Andras Lindsay M
Jackie and Gene Autry Children's Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA.
Department of Orthopedics, Boston Children's Hospital, Boston, MA.
Spine (Phila Pa 1976). 2025 May 1;50(9):E161-E166. doi: 10.1097/BRS.0000000000005139. Epub 2024 Aug 29.
Retrospective, multicenter.
Determine if posterior column osteotomies (PCO) at time of conversion from growth friendly instrumentation (GFI) to definitive fusion in early onset scoliosis (EOS) graduates impacts outcomes.
Increasing spinal rigidity following treatment of EOS with GFI can limit curve correction at time of conversion to definitive spinal fusion. PCO are often employed at the time of fusion to improve flexibility. This technique's efficacy has not been studied.
Patients with EOS with GFI undergoing conversion to fusion were grouped by those that did or did not have PCO. Patients with inadequate radiographs, <2 years follow-up, or three-column osteotomies at time of fusion were excluded.
Eight hundred thirty-two patients met inclusion criteria. One hundred seventy-five (21%) patients had PCO. Age at index surgery was younger (6.6 vs . 7.4 y, P =0.0009), and the mean duration of GFI was greater (6.2 vs. 5.5 y, P =0.009) in the PCO group. Before fusion, curve magnitude was similar between the groups (PCO=61.9°, no PCO=59.3°, P =0.18). On average 4.4 osteotomies (range: 1-12) were performed for the PCO group and EBL (PCO=820 cc vs . no PCO=752 cc, P <0.01) and surgical time (PCO=403 min vs . no PCO=349 min, P <0.01) were greater. Postoperatively, mean curve correction (PCO=16.6°, no PCO=14.4°, P =0.18) was similar. Accounting for preoperative curve magnitude, there was a relationship between number of PCOs and curve correction ( P =0.04). There was no relationship between degrees of correction per osteotomy and duration of GFI ( P =0.12). Postoperative complications at 2 years were similar (PCO=25% vs. no PCO=27%, P =0.63).
EOS graduates achieve minimal correction at time of conversion regardless of whether PCOs are performed. PCOs increase EBL and operative time but have a similar complication rate. More PCOs resulted in more correction, though less than that anticipated in a previously uninstrumented spine.
III.
回顾性、多中心研究。
确定早发性脊柱侧弯（EOS）患者从生长友好型器械（GFI）转换为确定性融合时进行后路椎体截骨术（PCO）是否会影响治疗结果。
用GFI治疗EOS后脊柱僵硬程度增加会限制转换为确定性脊柱融合时的曲线矫正。融合时通常采用PCO来提高灵活性。该技术的疗效尚未得到研究。
将接受从GFI转换为融合治疗的EOS患者按是否进行PCO分组。排除X线片质量不佳、随访时间不足2年或融合时进行三柱截骨术的患者。
832例患者符合纳入标准。175例（21%）患者进行了PCO。PCO组初次手术时年龄更小（6.6岁对7.4岁，P =0.0009），GFI平均使用时间更长（6.2年对5.5年，P =0.009）。融合前，两组的曲线严重程度相似（PCO组=61.9°，非PCO组=59.3°，P =0.18）。PCO组平均进行了4.4次截骨术（范围：1 - 12次），术中失血（PCO组=820毫升对非PCO组=752毫升，P <0.01）和手术时间（PCO组=403分钟对非PCO组=349分钟，P <0.01）更长。术后，平均曲线矫正相似（PCO组=16.6°，非PCO组=14.4°，P =0.18）。考虑术前曲线严重程度，PCO次数与曲线矫正之间存在关联（P =0.04）。每次截骨的矫正度数与GFI使用时间之间无关联（P =0.12）。2年时的术后并发症相似（PCO组=25%对非PCO组=27%，P =0.63）。
无论是否进行PCO，EOS患者在转换时矫正程度都很小。PCO会增加术中失血和手术时间，但并发症发生率相似。更多的PCO会带来更多的矫正，尽管比未使用器械的脊柱预期的要少。
III级
