Liang Mingqian,Li Haichong,Zhang Xuejun,et al.Clinical analysis of traditional growing rods technique for neurofibromatosis type 1 dystrophic scoliosis[J].Journal of Clinical Pediatric Surgery,2025,(04):320-325.[doi:10.3760/cma.j.cn101785-202410065-004]
传统生长棒技术治疗Ⅰ型神经纤维瘤病营养不良性脊柱侧凸的临床疗效分析
- Title:
- Clinical analysis of traditional growing rods technique for neurofibromatosis type 1 dystrophic scoliosis
- Keywords:
- Neurofibromatosis Type 1; Scoliosis; Dystrophy; Traditional Growing Rods; Intraoperative Complications; Postoperative Complications; Treatment Outcome
- 摘要:
- 目的 探讨使用双侧传统生长棒(traditional growing rods,TGRs)技术治疗Ⅰ型神经纤维瘤病(neurofibromatosis type 1,NF1)营养不良性脊柱侧凸的临床效果及相关并发症。方法 回顾性分析2016年3月至2021年7月首都医科大学附属北京儿童医院骨科收治的NF1营养不良性脊柱侧凸患儿临床资料。患儿均接受TGRs治疗并定期行再撑开手术,测量术前、术后及末次随访时的主弯Cobb角、第1~12胸椎高度(T1~T12 height,TTH)、第1胸椎至第1腰椎高度(T1~S1 height,TSH)、冠状面躯干偏移(trunk shift,TS)、局部后凸角(local kyphosis,LK)以及矢状面躯干偏移(sagittal vertebral axis,SVA)情况。结果 共31例患儿纳入研究,男17例、女14例,首次手术年龄平均6.8岁。与术前比较,TGRs术后即刻主弯Cobb角、TTH、TSH、LK、TS及SVA均较术前明显改善,差异有统计学意义 。随访2~7年,至末次随访时,患儿主弯Cobb角为(26.8±13.3)°、TTH为(22.1±2.8)cm、TSH为(36.1±4.0)cm,均较术后即刻进一步改善,差异有统计学意义(P<0.05)。随访期间发生螺钉脱出4例,生长棒断裂3例,远端附加现象1例,总并发症发生率为26%(8/31)。结论 TGRs技术治疗小年龄NF1营养不良性脊柱侧凸安全、有效,可以在保留患儿脊柱及胸廓生长能力的同时,有效控制脊柱畸形进展。
- Abstract:
- Objective To explore the clinical efficacies and related complications of bilateral traditional growing rods (TGRs) for neurofibromatosis type 1 (NF1) dystrophic scoliosis.Methods From March 2016 to July 2021,the clinical data were retrospectively reviewed for 31 children with NF1 dystrophic scoliosis.All children were treated with TGRs and underwent re-expansion regularly.Cobb angle,T1-T12 height (TTH),T1-S1 height (TSH),trunk shift (TS),local kyphosis (LK) and sagittal vertebral axis (SVA) were measured before,after operation and at the last follow-up.Results There were 17 boys and 14 girls with an average age of initial operation 6.8 years.Immediately post-operation,Cobb angle was compared with that pre-operation ,TTH ,TSH and LK.Both TS and SVA significantly improved compared with those pre-operation (P<0.05).Follow-up period was (2-7) years.At the last follow-up,Cobb angle was (26.8±13.3)°,TTH (22.1±2.8)cm and TSH (36.1±4.0)cm.All differences were statistically significant (P<0.05).During follow-ups,there were screw displacement (n=4),growing rod fracture (n=3) and distal adding-on phenomenon (n=1).The incidence of complications was 26%.Conclusions TGRs technique is both safe and effective for children with NF1 dystrophic scoliosis.It may effectively control the progress of spinal deformities while preserving the growth capability of spine and thorax.
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备注/Memo
收稿日期:2024-10-28。
基金项目:中央高水平医院临床科研基金(2022-PUMCH-D-004);国家重点研发计划(2023YFC2507701)
通讯作者:张学军,Email:zhang-x-j04@163.com