Li Chenkai, Ye Xiaohan, Yang Yang, Lin Guanfeng, Shen Jianxiong, Zhao Yu, Wu Nan, Zhuang Qianyu, Wang Shengru, Zhang Jianguo
Department of Orthopedics, Peking Union Medical College Hospital, Beijing, China.
Neurosurgery. 2024 Sep 12;96(5):975-85. doi: 10.1227/neu.0000000000003178.
Correction with traditional dual growing rods (TDGR) might not be sufficient for severe and rigid spinal deformity. TDGR combines with apical control techniques (ACT) could theoretically improve curve correction and decrease the incidence of mechanical complications. However, long-term results for TDGR with ACT are limited. The aim of this study was to retrospectively review and compare the outcomes of patients who graduated from TDGR with or without ACT.
Patients who were treated by TDGR with or without ACT with a minimum 2-year follow-up after graduation were enrolled. According to the intervention for the apex, patients were further divided into the TDGR group, the TDGR + apical control pedicle screws group (without apical fusion), and the TDGR + hybrid technique group. Clinical outcomes, radiological parameters, pulmonary function, and complications were compared among the 3 groups.
A total of 76 patients (51 patients in the TDGR group, 10 patients in the apical control pedicle screws group, and 15 patients in the hybrid technique group) were enrolled. Compared with TDGR, TDGR + ACT achieved better main curve correction, better control of apical vertebral translation and rotation, and lower incidence of complications and revision surgery (P < .05) while maintaining development of the spine and chest. Although the difference was not significant, patients in the TDGR + ACT group had better pulmonary function at the last follow-up (P > .05). The percentage of patients receiving final fusion in the TDGR + ACT group was significantly lower than that in the TDGR group (P < .05).
Compared with TDGR, TDGR + ACT can achieve better curve correction and apical control and comparable clinical outcomes while maintaining the growth of the spine and chest. Patients may derive more benefits from treatment with TDGR + ACT, including a lower incidence of mechanical complications and revision surgery, better pulmonary function, and the avoidance of final fusion.
对于严重且僵硬的脊柱畸形，采用传统双生长棒（TDGR）进行矫正可能并不充分。TDGR联合顶点控制技术（ACT）理论上可改善畸形矫正效果并降低机械并发症的发生率。然而，TDGR联合ACT的长期效果有限。本研究的目的是回顾性分析并比较接受或未接受ACT的TDGR治疗患者的疗效。
纳入接受TDGR治疗且毕业至少2年后进行了至少2年随访的患者。根据顶点干预措施，患者进一步分为TDGR组、TDGR + 顶点控制椎弓根螺钉组（未进行顶点融合）和TDGR + 混合技术组。比较三组的临床疗效、影像学参数、肺功能和并发症情况。
共纳入76例患者（TDGR组51例，顶点控制椎弓根螺钉组10例，混合技术组15例）。与TDGR相比，TDGR + ACT在维持脊柱和胸廓发育的同时，实现了更好的主弯矫正、更好地控制顶点椎体平移和旋转，并发症及翻修手术发生率更低（P <.05）。虽然差异不显著，但TDGR + ACT组患者在末次随访时肺功能更好（P >.05）。TDGR + ACT组接受最终融合的患者比例显著低于TDGR组（P <.05）。
与TDGR相比，TDGR + ACT在维持脊柱和胸廓生长的同时，能实现更好的畸形矫正和顶点控制，临床疗效相当。患者接受TDGR + ACT治疗可能获益更多，包括更低的机械并发症和翻修手术发生率、更好的肺功能以及避免最终融合。
