应用生长棒技术治疗小儿先天性脊柱侧凸对椎体生长发育的影响

The study of vertebral growth effected by growing rod in congenital scoliosis patients

中文关键词:  先天性脊柱侧凸  生长棒  椎体发育

英文关键词:Congenital scoliosis  Growing rod  Vertebral growth

中文摘要:

  【摘要】 目的：观察应用生长棒技术治疗先天性脊柱侧凸的疗效，探讨生长棒撑开手术对撑开节段内外脊柱和椎体生长发育的影响。方法：2008年6月~2013年12月采用生长棒技术治疗先天性脊柱侧凸患儿221例，术后至少有两次脊柱CT检查且2次检查间至少有1次撑开的患儿31例，男17例，女14例，首次手术时年龄3.2~9.1岁；第一次CT检查时年龄为7.1±2.3岁；末次CT检查时年龄为10.0±2.1岁。1.0~5.9年内共进92次撑开手术，人均撑开次数为3次，年均撑开次数为1.1次。第一次CT检查平均为第2次撑开，末次CT检查平均为第5次撑开。测量并比较第一次和末次CT检查时患者生长棒撑开节段内外椎体高度、主弯Cobb角、矢状位胸后凸Cobb角、T1~T12和T1~S1高度、脊柱偏移距离。结果：第一次和末次CT检查时撑开节段内单个椎体高度为18.2±4.7mm和21.8±5.5mm，撑开节段外单个椎体高度为19.2±3.2mm和22.7±3.4mm，前后两次撑开节段内外椎体高度有统计学差异（P=0.035）。撑开节段内、外单个椎体高度增加为1.4±0.9mm/yr、1.2±0.9mm/yr，差异有统计学意义（P＜0.05），撑开节段内椎体比撑开节段外椎体生长快。两次测量时冠状位主弯Cobb角分别为56.8°±15.3°和52.9°±15.4°，矢状位胸后凸Cobb角为36.6°±18.9°和43.7°±18.2°，T1~12高度为16.7±3.3cm和19.1±3.3cm，T1~S1高度为27.9±4.7cm和32.5±4.7cm，差异均有统计学意义（P＜0.05）；脊柱平移为18.6±15.2mm和20.0±21.4mm，差异无统计学意义（P＞0.05）。结论：应用生长棒技术治疗小儿先天性脊柱侧凸时撑开节段内的正常椎体生长速率快于撑开节段外的椎体生长速率，撑开期间胸椎和脊柱高度均相应增加。

英文摘要:

  【Abstract】 Objectives: To observe the vertebral growth effected by growing rod techniques in congenital scoliosis patients. Methods: 221 patients with congenital scoliosis who underwent growing rod surgery from June 2008 to December 2013 were documented. 31 cases had spine CT for at least 2 times scan before and after a re-lengthening surgery. The first surgery was performed at 3.2 to 9.1 years old. The first CT scan was performed at 7.1±2.3 years old. The last CT scan was at 10.0±2.1 years old. 92 re-lengthening operations were performed during 1.0-5.9 years. The re-lengthening rate was 3 times per person or 1.1 times per year. When patients had the first CT scan, they had average of 2 re-lengthening operations. When patients had the last CT scan, they had an average of 5 re-lengthening operations. Several parameters were documented including age, Cobb angle of main curve, lateral thoracic kyphosis Cobb angle, T1-T12 height, T1-S1 height and trunk shift. Results: The first and last CT scan showed the height of vertebra inside instrument was 18.2±4.7mm, 21.8±5.5mm respectively; and the height of vertebra outside instrument was 19.2±3.2mm, 22.7±3.4mm respectively. There was a significant difference between the height changes(P=0.035). The growth rate of vertebrae inside instruments was 0.2mm/yr faster than that vertebra outside instruments(1.4±0.9mm/yr vs 1.2±0.9mm/yr). The Cobb angle of main curve was 56.8°±15.3° and 52.9°±15.4° respectively, the thoracic kyphosis was 36.6°±18.9° and 43.7°±18.2° respectively, the T1-T12 height was 16.7±3.3cm and 19.1±3.3cm, and the T1-S1 height was 27.9±4.7cm and 32.5±4.7cm. There was a significant difference between each pair of parameters(P<0.05). The trunk shift was 18.6±15.2mm and 20.0±21.4mm, and there was no difference(P>0.05). Conclusions: The growing rod technique has a positive effect on the growth rate of the vertebra inside the instruments, which promotes the spine growth.