双生长棒技术治疗早发性脊柱侧凸的中期疗效

The efficacy and complications of dual growing rod technique for early onset scoliosis

中文关键词:  早发性脊柱侧凸  双生长棒技术  胸廓发育不良综合征  非融合技术

英文关键词:Early onset scoliosis  Dual growing rod technique  Thoracic insufficiency syndrome  Fusionless technique

中文摘要:

  【摘要】 目的：评估双生长棒技术治疗5岁以下早发性脊柱侧凸患儿的中期疗效，分析相关并发症原因。方法：回顾性研究2004年2月～2012年6月于我科接受双生长棒技术治疗的14例（男4例，女10例）早发性脊柱侧凸患儿；平均年龄3.5±1.2岁（2～5岁）。通过复习病历，对年龄、撑开次数以及并发症进行记录；同时对影像学资料进行测量分析。测量指标包括侧凸Cobb角、胸后凸、腰前凸、T1-S1距离以及内固定的长度，对畸形的矫正情况以及脊柱、胸廓的生长指标———坎贝尔的空间供肺比值（Campbell′s space available for lung ratio，SAL）进行评估。结果：所有患儿平均随访时间为54.6±22.4个月（24～100个月）。14例患儿共接受99次手术，其中85次为撑开术，平均每例患者经历6.1次撑开术。冠状面主弯Cobb角术前73.8°±19.1°，术后35.8°±12.8°，末次随访时34.5°±16.3°。T1-S1距离从术前23.9±4.2cm增至术后27.1±4.8cm，末次随访时为33.6±5.2cm，平均年增长率为1.61cm/y。内固定长度初次手术术后为23.1±5.3cm，末次随访时为28.0±6.2cm。SAL术前为0.90±0.10，术后改善至0.92±0.09，末次随访时为0.96±0.11。有4例患者发生8例次并发症，主要为内固定相关（7例次）并发症，均在撑开手术同时进行翻修；无感染以及神经系统并发症发生。结论：双生长棒技术用于治疗5岁以下、保守治疗无效的进展性早发性脊柱侧凸患儿，不仅可以有效地控制脊柱畸形的进展，保留脊柱的生长潜能，而且对患儿胸廓畸形也具有一定的矫正作用；尽管该技术内固定失败发生率较高，但通过翻修手术仍可以获得满意的临床疗效。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcomes of the dual growing rod technique for early onset scoliosis(EOS). Methods: 14 patients(4 males, 10 females) undergoing dual growing rod technique for severe rigid congenital scoliosis in our hospital from February 2006 to June 2012 were retrospectively studied. The average age was 3.5±1.2 years(range, 2-5 years). The mean follow-up was 54.6±22.4(range, 24-100) months. The patients′ charts were reviewed. The parameters included age at initial surgery and the final follow-up, number and frequency of lengthening, and complications. Radiographic evaluation included scoliosis Cobb angle, thoracic kyphosis, lumber lordosis, trunk shift, length of T1-S1 and instrumentation. Results: There was a total of 99 surgeries, 85(14 patients) of them were lengthening procedures. The average lengthening was of 6.1cm per patient. The mean scoliosis improved from 73.8°±19.1° to 35.8°±12.8° after initial surgery and was 34.5°±16.3° at the final follow-up. The average T1-S1 length was of 1.61cm per year. The SAL increased from 0.90±0.10 to 0.96±0.11 after initial surgery and was 0.96±0.11 at the final follow-up. Eight complications occurred in 4 patients and most of them were implant-related(7 complications), underwent revision surgery at the same time of lengthening procedures. No infection and complications of nervous system. Conclusions: For patients with progressive EOS and age of 5 years, dual growing rod technique can maintain correction achieved at initial surgery while allowing spinal growth. The deformity of thoracic cage can be improved while the growth potential of the thoracic cage is preserved. However, this technique requires multiple numbers of lengthening procedures and thus has higher risk of complications. These factors should be evaluated carefully before the surgery.