摘要
目的探究生长棒技术治疗早发性脊柱侧凸时近端不同锚定点数量对疗效及并发症的影响。方法以2016年1月至2020年3月首都医科大学附属北京儿童医院收治的33例采用传统双侧生长棒技术治疗的早发性脊柱侧凸患者为研究对象,所有患者随访时间≥2年,撑开次数≥2次,术前、术后及末次随访时影像学资料完整。按照近端锚定点数量不同将患者分为2组:A组近端远端各4个锚定点,共8个锚定点(15例);B组近端6个锚定点,远端4个锚定点,共10个锚定点(18例)。记录患者年龄、性别、随访时间、术前和末次随访时主侧弯Cobb角、T1-S1高度、冠状面偏移程度、影像学肩关节高度差、胸椎后凸Cobb角、矢状面偏移情况,以及随访期间椎弓根螺钉松动、移位、拔出、断棒、翻修情况。结果两组患者术前年龄、不同性别例数、随访时间、撑开次数的差异无统计学意义(P>0.05)。两组末次随访时主侧弯Cobb角均较术前减小,末次随访时T1-S1高度均较术前增大,差异有统计学意义(P<0.05)。A组术前与末次随访时相比,胸椎后凸Cobb角差异无统计学意义(P>0.05)。B组末次随访时胸椎后凸Cobb角较术前减小,差异有统计学意义(P<0.05)。末次随访与术前比较,主侧弯Cobb角的变化值及胸椎后凸Cobb角的变化值,B组均大于A组,差异有统计学意义(P<0.05)。结论传统双侧生长棒技术治疗EOS时,采用近端4个锚定点与6个锚定点均能取得冠状面侧弯的矫正,同时保持脊柱的生长;但采用近端6个锚定点可获得更大的冠状面主侧弯矫形力度和矢状面胸椎后凸的改善,同时锚定点相关并发症发生率更低。对于大的冠状面主侧弯(Cobb角>70°),尤其是合并较大胸椎后凸畸形(Cobb角>40°)的EOS,可以考虑增加锚定点。
Objective To compare the surgical outcomes in different number of proximal anchor points on bilateral growing rod technique in the Treatment of early onset scoliosis.Methods All EOS patients treated with bilateral growing rod technique in our hospital from January 2016 to March 2020 were retrospectively reviewed.Patients with complete imaging data of preoperative,postoperative and last follow-up,follow-up time≥2 years,lengthening procedure≥2 times were included in this study.Patients were divided into 2 groups according to the number of anchor points:A group,4 proximal anchor points and 4 distal anchor points,15 cases;B group,6 proximal anchor points and 4 distal anchor points,18 cases.Cobb angle of main curve(MC),T1-S1 height,C7PL-CSVL distance,radiographic shoulder height(RSH),Cobb angle of thoracic kyphosis(TK),sagittal vertical axis(SVA),unplanned surgery,Implant complications were recorded during follow-up.These parameters were analyzed.Results There was no significant difference in preoperative age,number of different genders,follow-up time and lengthening procedures between the two groups(P>0.05).The Cobb angle of MC decreased and the T1-S1 height increased in the last follow-up between the two groups(P<0.05).There was no significant difference in the Cobb angle of TK between preoperative and last follow-up in group A(P>0.05),but Cobb angle of TK decreased compared with preoperative at the last follow-up in group B was significant differences(P<0.05).The change value of MC Cobb angle and TK Cobb angle compared between preoperative and the last follow-up was larger in group B than group A(P<0.05).Conclusion Both 4 proximal anchor points and 6 proximal anchor points can effectively correct the coronal main curve and maintain the growth of the spine.However,larger correction degree of MC and TK were achieved in 6 proximal anchor points group;Meanwhile,anchor-related complications were lower.The use of additional anchor points may be considered for large MC(cobb angle>70°),especially for the patient with
作者
朱伟玮
张学军
曹隽
叶文松
白云松
郭东
姚子明
Zhu Weiwei;Zhang Xuejun;Cao Jun;Ye Wensong;Bai Yunsong;Guo Dong;Yao Ziming(Children’s Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou,310052;Beijing Children’s Hospital,Capital Medical University,National Children’s Medical Center,Beijing,100045)
出处
《临床小儿外科杂志》
CAS
CSCD
2021年第1期14-18,共5页
Journal of Clinical Pediatric Surgery
基金
北京市医院管理局“扬帆”计划(编号:XLML201818)。
