Liu Hu,Sun Lin,Zhang Xuejun.Efficacies of spine-rib versus spine-spine distraction for early-onset scoliosis[J].Journal of Clinical Pediatric Surgery,2019,18(07):588-593.[doi:10.3969/j.issn.1671-6353.2019.07.014]
椎体-肋骨撑开术及椎体-椎体撑开术治疗早发性脊柱侧凸患儿的疗效比较
- Title:
- Efficacies of spine-rib versus spine-spine distraction for early-onset scoliosis
- Keywords:
- Scoliosis; Orthopedic Procedures
- 分类号:
- R726.8;R681.5;R687
- 摘要:
- 目的 针对椎体-肋骨撑开术与椎体-椎体撑开术两种不同术式治疗早发性脊柱侧凸患儿的疗效进行对比分析。方法 以首都医科大学附属北京儿童医院2005-2010年接受椎体-肋骨撑开术（为椎体-肋骨撑开组）或椎体-椎体撑开术（为椎体-椎体撑开组）治疗的早发性脊柱侧凸患儿为研究对象。比较两组初次手术前后及末次随访时冠状位主弯Cobb角、胸椎后凸角、胸廓（T1至T12）椎体高度及肺功能变化，并记录两组患儿术后并发症情况。结果 本研究共纳入28例患儿（椎体-肋骨撑开组和椎体-椎体撑开组各14例）。两组患儿脊柱侧凸类型构成比、初次手术年龄和平均随访时间均无统计学差异（P>0.05）。椎体-肋骨撑开组主弯Cobb角的初次手术矫正率及末次手术矫正率均低于椎体-椎体撑开组（P<0.05）。椎体-肋骨撑开组和椎体-椎体撑开组患儿初次手术前的平均胸廓（T1至T12）高度无统计学差异（P>0.05），但两组患儿末次随访时的胸廓（T1至T12）高度与各自初次术前的胸廓高度相比均有明显增加（P<0.05）。末次随访时，两组患儿的胸廓（T1至T12）高度存在统计学差异（P<0.05）。两组末次随访时FVC、FEV1值均高于初次手术前水平（P<0.05）。椎体-肋骨撑开组的并发症发生率大于椎体-椎体撑开组（P<0.05）。结论 椎体-肋骨撑开术与传统生长棒椎体-椎体撑开术矫形效果相同，均可有效地矫正早发性脊柱侧凸患儿的脊柱畸形并改善术后肺功能。对于胸廓畸形严重、椎体发育较差的EOS患儿是首选的手术治疗方法。
- Abstract:
- Objective To compare the efficacies of spine-rib versus spine-spine distraction for children with early-onset scoliosis (EOS).Methods The clinical data for 28 EOS patients were reviewed.They were divided into two groups of spine-rib distraction (n=14) and spine-spine distraction (n=14).Anteroposterior and lateral radiographic films were taken to measure the values of coronal Cobb’s angle and sagittal thoracic kyphosis angle at before and after surgery and the final follow-up.Thoracic vertebral heights and pulmonary function test (forced vital capacity[FVC] + forced expired volume in 1 second[FEV1] both% predicted) were measured before and after surgery.And the complications were recorded in both groups.Results The follow-up period was over 3 years.Both patient groups had similar diagnoses and age at initial surgery (P>0.05).Correction and correction rate before and after surgery were less in spine-rib distraction group than those of spine-spine group.Sagittal thoracic kyphosis showed no significant inter-group difference before and after surgery and at the final follow-up (P>0.05).And sagittal thoracic kyphosis correction rate was similar at before surgery and the final follow-up (P>0.05).The mean mean preoperative height of thoracic spine (T1-T12) showed no statistical inter-group difference and higher at final follow-up than preoperative (P<0.05).Statistically significant inter-group difference existed in height of thoracic spine at the last follow-up.The annual growth rate of thoracic spine (T1-T12) had statistically significant inter-group difference (P<0.05).The overall complication rate was higher in spine-rib distraction group than that in spine-spine distraction group(P<0.05).Conclusion The efficacy of spine-rib distraction group is the same as that of spine-spine distraction and correction of spinal deformities is effective in EOS children.Spine-rib distraction controls the progression of spinal deformity and maintains spinal growth.And there is significant improvement in postoperative pulmonary function tests.It is the first choice of surgical treatment for EOS children with severe thoracic deformity and poor vertebral development.
参考文献/References:
1 El-Hawary R,Akbarnia BA.Early Onset Scoliosis-Time for Consensus[J].Spine Deformity,2015,3(2):105-106. DOI:10.1016/j.jspd,2015.01.003.
2 Skaggs DL,Guillaume T,El-Hawary R.Early Onset Scoliosis Consensus Statement,SRS Growing Spine Committee,2015[J].Spine Deformity,2015,3(2):107.DOI:10.1016/j.ispd.2015.001.002.
3 Canavese F,Dimeglio A.Normal and abnormal spine and thoracic cage development[J].World J Orthop,2013,4(4):167-174.DOI:10.5312/wjo.v4.i4.167.
4 Pehrsson K,Larsson S,Oden A,et al.Long-term follow-up of patients with untreated scoliosis.A study of mortality,causes of death,and symptoms[J].Spine,1992,17(9):1091-1096.
5 Akbarnia BA,Breakwell LM,Marks DS,et al.Dual growing rod technique followed for three to eleven years until final fusion:the effect of frequency of lengthening[J].Spine,2008,33(9):984-990.DOI:10.1097/BRS.0b013e31816c8b4e.
6 Akbarnia BA,Marks DS,Boachie-Adjei O,et al.Dual growing rod technique for the treatment of progressive early-onset scoliosis:a multicenter study[J].Spine,2005,30(17 Suppl):46.
7 Campbell MR Jr,Hellvocke AK.Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty[J].Spine Journal,2003,2(5):71-72.
8 El-Hawary R,Samdani A,Wade J,et al.Rib-based Distraction Surgery Maintains Total Spine Growth[J].J Pediatr Orthop,2016,36(8):841-846.DOI:10.1097/BPO.0000000000000567.
9 Emans JB,Caubet JF,Ordonez CL,et al.The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib:growth of thoracic spine and improvement of lung volumes[J].Spine,2005,30(17 Suppl):58.DOI:10.1097/01.brs.0000175194.31986.2f.
10 Flynn JM,Emans JB,Smith JT,et al.VEPTR to treat nonsyndromic congenital scoliosis:a multicenter,mid-term follow-up study[J].J Pediatr Orthop,2013,33(7):679-684.DOI:10.1097/BPO.0b013e31829d55a2.
11 Hasler CC,Mehrkens A,Hefti F.Efficacy and safety of VEPTR instrumentation for progressive spine deformities in young children without rib fusions[J].Eur Spine J,2010,19(3):400-408.DOI:10.1007/s00586-009-1253-9.
12 Skaggs DL,Sankar WN,Albrektson J,et al.Weight gain following vertical expandable prosthetic titanium ribs surgery in children with thoracic insufficiency syndrome[J].Spine,2009,34(23):2530-2533.DOI:10.1097/BRS.0b0 13e3181bd09f5.
13 Dede O,Motoyama EK,Yang CI,et al.Pulmonary and Radiographic Outcomes of VEPTR (Vertical Expandable Prosthetic Titanium Rib) Treatment in Early-Onset Scoliosis[J].J Bone Joint Surg Am,2014,96(15):1295-1302.DOI:10.2106/JBJS.M.01218.
14 Waldhausen JH,Redding G,White K,et al.Complications in using the vertical expandable prosthetic titanium rib (VEPTR) in children[J].J Pediatr Surg,2016,51(11):1747-1750.DOI:10.1016/j.jpedsurg.2016.06.014.
15 Farooq N,Garrido E,Altaf F,et al.Minimizing complications with single submuscular growing rods:a review of technique and results on 88 patients with minimum two-year follow-up[J].Spine,2010,35(25):2252-2258.DOI:10.1097/BRS.0b013e3181ecf41a.
16 Watanabek K,Uno K,Suzuki T,et al.Risk factors for complications associated with growing-rod surgery for early-onset scoliosis[J].Spine,2013,38(8):464-468. DOI:10.1097/BRS.0b013e318288671a.
17 Campbell RM Jr,Smith MD,Mayes TC,et al.The effect of opening wedge thoracostomy on thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis[J].J Bone Joint Surg Am,2004,86(8):1659-1674.
18 Motoyama EK,Yang CL.Thoracic malformation with early-onset scoliosis:effect of serial VEPTR expansion thoracoplasty on lung growth and function in children[J].Paediatr Respir Rev,2009,10(1):12-17. DOI:10.1016/j.prrv.2008.10.004.
19 Campbell RM,Smith MD,Hell-Vocke AK.Expansion Thoracoplasty:The Surgical Technique of Opening-Wedge Thoracostomy[J].The Journal of Bone and Joint Surgery,2004,86(Suppl 1):51-64.
20 Gomez JA,Lee JK,Kim PD,et al."Growth friendly" spine surgery:management options for the young child with scoliosis[J].J Am Acad Orthop Surg,2011,19(12):722-727.
21 Bess S,Akbarnia BA,Thompson GH,et al.Complications of growing-rod treatment for early-onset scoliosis:analysis of one hundred and forty patients[J].Journal of Bone & Joint Surgery American Volume,2010,92(15):2533.DOI:10.2106/JBJS.I.01471.
22 Karol LA,Johnston C,Mladenov K,et al.Pulmonary function following early thoracic fusion in non-neuromuscular scoliosis[J].J Bone Joint Surg Am,2008,90(6):1272-1281.DOI:10.2106/JBJS.G.00184.
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备注/Memo
收稿日期:2018-8-21。
基金项目:北京市医院医管局"扬帆"计划临床技术创新项目（编号：XMLX201818）
通讯作者:孙琳,Email:marksunhk@126.com