[1]祁新禹,姚子明,郭东,等. 生长棒撑开后最终融合手术治疗早发性脊柱侧凸的临床效果[J].临床小儿外科杂志,2018,17(11):830-834.
　Qi Xinyu,Yao Ziming,Guo Dong,et al. Outcome of definitive fusion after growingrod treatment of earlyonset scoliosis.[J].Journal of Clinical Pediatric Surgery,2018,17(11):830-834.
点击复制

 生长棒撑开后最终融合手术治疗早发性脊柱侧凸的临床效果

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第17卷 期数: 2018年11期 页码: 830-834 栏目: 论著 出版日期: 2018-11-20
Title:
 Outcome of definitive fusion after growingrod treatment of earlyonset scoliosis.
作者:
 祁新禹; 姚子明; 郭东; 等.
 国家儿童医学中心，首都医科大学附属北京儿童医院骨科
Author(s):
 Qi Xinyu; Yao Ziming; Guo Dong; Bai Yunsong; Li Chengxin; Sun Baosheng; Zhang Xuejun.
 Department of Orthopedics,Affiliated Beijing Childrens Hospital,Capital Medical University & National Center for Childrens Health,Beijing 100045,China.
关键词:
 ; 早发性脊柱侧凸;  外科手术;  治疗;  并发症
Keywords:
 ; Early Onset Scoliosis;  Surgical Procedures;  Operative;  Therapy;  Complication
文献标志码:
A
摘要:
 目的评估经生长棒撑开术治疗早发性脊柱侧凸（earlyonset scoliosis, EOS）后行最终矫形融合手术患儿的临床效果。方法回顾性分析2007年7月至2014年6月于北京儿童医院接受生长棒撑开技术治疗并行最终融合手术的26例EOS患儿临床资料(男15例,女11例)；初次手术平均年龄（5.2±2.6）岁。对病因、最终融合手术年龄、撑开次数、固定节段数及并发症等临床资料进行记录；同时对影像学资料（Cobb角、胸椎高度、脊柱高度）进行测量分析。结果26例均行最终矫形融合手术，平均年龄为（13.2±2.3）岁。26例患儿中，17例为先天性脊柱侧凸，6例I型神经纤维瘤病脊柱侧凸，3例幼儿特发性脊柱侧凸；畸形顶椎位于胸段患儿15例，胸腰段8例，腰段3例；平均每例患儿经历8.2次撑开术，平均撑开时间间隔为（11.7±2.6）个月。术前冠状面主弯Cobb角为（69.3±30.8）°,末次撑开术后为（49.4±22.9）°,最终融合术后为（34.7±14.6）°。T1至T12距离从术前的（15.4±2.7）cm增至末次撑开术后的（22.5±3.6）cm,最终融合术后达（22.9±3.5）cm；T1至S1距离从术前的（24.8±4.2）cm增至末次撑开术后的（32.5±4.8）cm,最终融合术后达（33.6±5.2）cm。12例（46%）患儿共出现并发症14例次，主要为内固定相关并发症（12例次，85.71%）,均在撑开手术同时进行翻修；无一例出现神经系统并发症。结论利用生长棒撑开技术治疗EOS患儿可有效控制其脊柱畸形的进展，并保留脊柱及胸廓的生长潜能。最终矫形融合手术的侧凸矫正率约为30%，适用于10岁以上骨骼发育相对成熟、反复出现内固定失败及畸形难以控制的患儿。
Abstract:
 ObjectiveTo explore the clinical efficacy and complications of definitive fusion after growing-rod treatment of early-onset scoliosis (EOS)．MethodsFrom July 2007 to June 2014，26 EOS children (15 boys and 11 girls) underwent growingrod and definitive fusion at our department were selected．The age at initial surgery was (5.2±2.6) years. Etiology, age at definitive fusion, number of distraction, instrumented segments and complications were recorded and reviewed. And radiographic data including Cobb angle of major curve, T1T12 height and T1S1 height were measured．The changes of these parameters were analyzed. ResultsAll of them underwent definitive fusion at an average age of (13.2±2.1) years. The diagnoses were congenital scoliosis (n=17), neurofibromatosis type I scoliosis (n=6) and idiopathic scoliosis (n=3). And the curves were thoracic (n=15), thoracolumbar (n=8) and lumbar (n=3). All of them were operated for 240 times and 188 had distractive options with a mean of 8.2 distractions for each. The mean distractive interval was 11.7±2.6 months. The Cobb angle improved from （69.3±30.8）° to （49.4±22.9）° after the last distractive surgery and 34.7°±14.6° after definitive fusion. The T1T12 height improved from （15.4±2.7） cm to （22.5±3.6） cm after the last distractive option and （22.9±3.5） cm after final fusion. Similarly, T1S1 height improved from （24.8±4.2） cm to （32.5±4.8） cm after the last distractive option and （33.6±5.2） cm after final fusion. In 12 children (46%), 14 complications occurred. And instrumentationrelated complication was the most frequent and there was no neurological complications.ConclusionWith an incidence of complication at 46%, growingrod technique is effective for EOS. It may control curve progression and preserve spinal and thoracic growth ability. Definitive fusion is appropriate for children aged over 10 years with unacceptable or progressive major curve deformity or complications with previous implants.

相似文献/References:

[1]刘婷婷 张钦明 周红 焦丽丽 陈永卫. 肠内营养在儿童胰腺外伤治疗中的应用[J].临床小儿外科杂志,2011,10(02):84.
　LIU Ting ting,ZHANG Qin ming,ZHOU Hong,et al. Enteral nutrition treatment in the application of pancreas trauma of children.[J].Journal of Clinical Pediatric Surgery,2011,10(11):84.
[2]吴卫卫 汪健 黄顺根. 肠外营养导致大鼠肝细胞炎症因子及受体基因表达的变化及临床意义[J].临床小儿外科杂志,2011,10(02):87.
　 Parenteral Nutrition Leads to Alteration of Inflammation Cytokines and Receptors Gene Expression in the Rat[J].Journal of Clinical Pediatric Surgery,2011,10(11):87.
[3]于增文 杨杨 李索林 耿娜 李英超 李萌 马亚贞. 腹腔镜下十二指肠单层缝合吻合术的实验研究与临床应用[J].临床小儿外科杂志,2011,10(02):90.
　YU Zen gwen,YANG Yang,LI Suo lin,et al. The experimental studies and clinical applications of laparoscopic duodenal singlelayer sutured anastomosis in children.[J].Journal of Clinical Pediatric Surgery,2011,10(11):90.
[4]徐织 王剑 傅启华 杨波 宋云海 鲍南.中国人群神经管缺陷VANGL1基因突变的筛查及关联研究[J].临床小儿外科杂志,2011,10(02):94.
　 Mutation screening and associated study of VANGL1 gene in chinese patients with Neural Tube Defects.[J].Journal of Clinical Pediatric Surgery,2011,10(11):94.
[5]丁晋阳 莫绪明 顾海涛 孙剑 彭卫 戚继荣 沈立 束亚琴 钱龙宝. 延迟关胸技术在婴儿复杂危重先心病手术中的应用[J].临床小儿外科杂志,2011,10(02):98.
　DING Jin yang,MO Xu ming,GU Hai tao,et al. Delayed Sternal Closure following operations for complex and severe congenital heart disease in infant[J].Journal of Clinical Pediatric Surgery,2011,10(11):98.
[6]吴臻斐 林孝坤 秦乐 林进汉 李仲荣 陈肖鸣. 西地那非对大鼠单侧睾丸扭转后对侧睾丸的影响及作用研究[J].临床小儿外科杂志,2011,10(02):101.
　[J].Journal of Clinical Pediatric Surgery,2011,10(11):101.
[7]王贤书 张晓茹 杨志国 程征海 岳芳 曹红宾 李德泽. 脑室腹腔分流术治疗婴儿脑积水120例 [J].临床小儿外科杂志,2011,10(02):105.
[8]杨洋 张潍平 彭芸 温洋 杨吉刚.两种输尿管不全梗阻肾积水动物模型制作方法的比较[J].临床小儿外科杂志,2011,10(02):107.
　 Comparison of two different methods to establish animal model of hydronephrosis due to incomplete ureteral obstruction.[J].Journal of Clinical Pediatric Surgery,2011,10(11):107.
[9]俞钢 朱小春 葛午平 林炎坤 金龙 劳伟华 史浩 肖尚杰 洪淳 周佳亮 傅晓静. 胎儿外科相关疾病的产前诊断及干预[J].临床小儿外科杂志,2011,10(02):111.
　 The antenatal diagnosis, tassessment, and therapy of fetal surgical anomalies[J].Journal of Clinical Pediatric Surgery,2011,10(11):111.
[10]刘国庆 王剑锋 朵永福 李杰荣 陈一平 黄振强 叶章群. 妊娠期尿结石对胎儿早产流产的影响[J].临床小儿外科杂志,2011,10(02):115.
　 Urolithiasis influence to develop of fetus in gestation period[J].Journal of Clinical Pediatric Surgery,2011,10(11):115.

更新日期/Last Update: 2018-11-23