纵向可撑开型人工钛肋技术治疗早发性脊柱侧凸合并肩部失平衡的疗效观察

Observation on the effest of vertical expandable prosthetic titanium rib technique on shoulder imbalance in children with early-onset scoliosis

中文关键词:  早发性脊柱侧凸  纵向可撑开型人工钛肋技术  肩部平衡

英文关键词:Early-onset scoliosis  Vertical expandable prosthetic titanium rib  Shoulder balance

中文摘要:

  【摘要】 目的：评估纵向可撑开型人工钛肋技术（vertical expandable prosthetic titanium rib，VEPTR）治疗早发性脊柱侧凸（early onset scoliosis，EOS）合并肩部失衡的疗效。方法：回顾性分析在我院行VEPTR技术治疗的8例EOS合并肩部失衡的患者，其中男6例，女2例。初次手术年龄5.0±3.4岁（3~10岁），撑开间隔时间为6~12个月，随访3年以上。比较初次术前、初次术后以及末次随访时的侧凸Cobb角、顶椎偏移、喙突高度差（coracoid height difference，CHD）、锁骨角（clavicle angle，CA）、锁骨倾斜角差（clavicular tilt angle difference， CTAD）和躯干偏移距离（trunk shift，TS）。结果：VEPTR术后随访56±8个月（43~70个月）。全部患者共接受手术46次，平均5.8次/例；共进行撑开延长手术38次，平均4.8次/例（3～6次），平均10个月行撑开延长一次。初次术前、术后和末次随访时的主弯Cobb角分别为82°±19°、49°±19°和52°±18°，顶椎偏移分别为48±17mm、32±12mm和36±12mm，末次随访均较术前有明显改善（P<0.05）。胸椎高度由术前13.2±2.1cm增加到术后15.0±2.2cm，末次随访时增加至18.3±2.4cm；T1-S1高度由术前24.3±3.7cm增加到术后27.8±4.8cm，末次随访时增加至33.8±5.1cm。CHD初次术前为25±5mm，初次术后减至19±6mm（P=0.001），末次随访时为11±4mm（P<0.001）。CA、CTAD初次术前分别为9°±2°和13°±4°，初次术后分别降低为6°±4°和11°±4°（P<0.05），末次随访时则分别降低至5°±4°和9°±4°（P<0.05）。术前的CHD与TS进行相关性分析，结果显示二者存在显著性正相关（r=0.716，P<0.05）。TS初次术前为31±13mm，初次术后减至14±7mm（P=0.011），末次随访时为16±7mm（P=0.007）。结论：VEPTR技术作为一种非融合性矫形技术，依靠纵向撑开力可有效控制EOS患者主弯畸形的进展，维持脊柱的生长，还可促进肩部平衡的改善。

英文摘要:

  【Abstract】 Objectives: To investigate the effectiveness of vertical expandable prosthetic titanium rib(VEPTR) technique in treating shoulder imbalance in children with early-onset scoliosis(EOS). Methods: 8 EOS patients(6 boys and 2 girls) with obvious shoulder imbalance treated with VEPTR technique were reviewed. The average age at the index surgery was 5.0±3.4 years old(range, 3-10 years). During the regular post-operative follow-up, expansion surgery was scheduled at an interval of 6 to 12 months. They had a minimum 3-year follow-up. Measurements of primary curve magnitude, apical vertebral translation(AVT), coracoid height difference(CHD), clavicle angle(CA), clavicular tilt angle difference(CTAD) and trunk shift(TS) were performed on radiographs, and the indexes at preoperation were compared with those at postoperation, and the latest follow-up. Results: All patients had a mean follow-up of 56±8 months (range, 43-70 months). 46 surgeries in total were performed, averaging 5.8 surgeries per patient; and 38 expansion surgeries were carried out, averaging 4.8 surgeries per patient. The average interval for each expansion surgery was 10 months. From preoperation to latest follow-up, the Cobb angle of primary curves was averagely corrected from 82°±19° to 52°±18°, and AVT displayed slight improvement. The average thoracic height increased from 13.2±2.1cm to 18.3±2.4cm, and the average T1-S1 height increased from 24.3±3.7cm to 33.8±5.1cm. After the index surgery, CHD, CA and CTAD improved from 25±5mm to 19±6mm, from 9°±2° to 6°±4°, and from 13°±4° to 11°±4°, respectively. At the latest follow-up, CHD, CA and CTAD were 11±4mm, 5°±4° and 9°±4° on average, respectively. TS was found to be significantly correlated with CHD before surgery. TS was averagely corrected from 31±13mm to 16±7mm from preoperation to latest follow-up. Conclusions: In EOS patients, VEPTR technique serves as an optional fusionless strategy to prevent curve progression, to allow growth of spine, as well as to improve shoulder imbalance.