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）...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。展开更多
The treatments for early-onset scoliosis(EOS)remain great challenges for spine surgeons.This study aimed to comprehensively review the treatments for EOS,especially the advancements made in the last decade.Current stu...The treatments for early-onset scoliosis(EOS)remain great challenges for spine surgeons.This study aimed to comprehensively review the treatments for EOS,especially the advancements made in the last decade.Current studies on EOS were retrieved through a search on PubMed,UpToDate,the Web of Science Core Collection and Scopus were reviewed.The most pertinent information related to the current treatments for EOS was collected.The foci of treatments for EOS have included creating a well-developed thoracic cavity,improving lung volume,and improving pulmonary function.Conservative treatments include bracing,casting,halo-gravity traction,and physiotherapy.Serial casting is the most effective conservative treatment for EOS.Surgical treatments mainly include growth-friendly techniques,which are generally classified into three types according to the amount of correction force applied:distraction-based,compression-based,and growth-guided.The distraction-based systems include traditional or conventional growing rods,magnetically controlled growing rods,and vertical expandable prosthesis titanium ribs.The compression-based systems include vertebral body stapling and tethering.The growth-guided systems include the Shilla system and modern Luque trolley.In addition,some newer techniques have emerged in recent years,such as posterior dynamic deformity correction(ApiFix).For EOS patients presenting with sharp deformities in a long,congenital spinal deformity,a hybrid technique,one-stage posterior osteotomy with short segmental fusion and dual growing rods,may be a good choice.Hemivertebra resection is the gold standard for congenital scoliosis caused by single hemivertebra.Although the patient’s growth potential is preserved in growth-friendly surgeries,a high complication rate should be expected,as well as a prolonged treatment duration and additional costs.Knowledge about EOS and its treatment options is rapidly expanding.Conservative treatments have specific limitations.For curves requiring a surgical intervention,surgical techniques may vary depending on the patients’characteristics,the surgeon’s experience,and the actual state of the country.展开更多
文摘目的：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。
基金The study was granted by a grant from the National Natural Science Foundation of China(No.81972037).
文摘The treatments for early-onset scoliosis(EOS)remain great challenges for spine surgeons.This study aimed to comprehensively review the treatments for EOS,especially the advancements made in the last decade.Current studies on EOS were retrieved through a search on PubMed,UpToDate,the Web of Science Core Collection and Scopus were reviewed.The most pertinent information related to the current treatments for EOS was collected.The foci of treatments for EOS have included creating a well-developed thoracic cavity,improving lung volume,and improving pulmonary function.Conservative treatments include bracing,casting,halo-gravity traction,and physiotherapy.Serial casting is the most effective conservative treatment for EOS.Surgical treatments mainly include growth-friendly techniques,which are generally classified into three types according to the amount of correction force applied:distraction-based,compression-based,and growth-guided.The distraction-based systems include traditional or conventional growing rods,magnetically controlled growing rods,and vertical expandable prosthesis titanium ribs.The compression-based systems include vertebral body stapling and tethering.The growth-guided systems include the Shilla system and modern Luque trolley.In addition,some newer techniques have emerged in recent years,such as posterior dynamic deformity correction(ApiFix).For EOS patients presenting with sharp deformities in a long,congenital spinal deformity,a hybrid technique,one-stage posterior osteotomy with short segmental fusion and dual growing rods,may be a good choice.Hemivertebra resection is the gold standard for congenital scoliosis caused by single hemivertebra.Although the patient’s growth potential is preserved in growth-friendly surgeries,a high complication rate should be expected,as well as a prolonged treatment duration and additional costs.Knowledge about EOS and its treatment options is rapidly expanding.Conservative treatments have specific limitations.For curves requiring a surgical intervention,surgical techniques may vary depending on the patients’characteristics,the surgeon’s experience,and the actual state of the country.
