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生长棒技术治疗先天性脊柱侧凸的疗效以及并发症分析

Analysis of clinical results and complications of growing rod technique for congenital scoliosis

摘要:

目的 评估生长棒技术治疗先天性脊柱侧凸的临床疗效与并发症.方法 回顾性研究2002年8月至2009年10月接受后路生长棒矫形术的34例先天性脊柱侧凸患者资料,其中男性12例,女性22例;年龄2 ~ 13岁,平均6.9岁.其中4例接受后路单侧生长棒矫形手术(单棒组),30例接受双侧生长棒矫形手术(双棒组).撑开手术的时机选择在2008年之前为畸形加重超过10°或者身高增长2 cm;2008年之后改为每6个月进行规律撑开.对患者的年龄、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,在X线上测量冠状面侧凸Cobb角、躯干偏移、T1 ~ S1长度、矢状面上胸后凸Cobb角以及腰前凸Cobb角.结果 患者随访时间24~110个月,平均40.5个月.单棒组4例患者共施行28次手术,其中20次为撑开术,平均每例患者经历5次撑开.冠状面主弯侧凸Cobb角术前平均80.9°,术后即刻59.5°,末次随访时65.3°.T1~S1长度从术前平均24.3 cm增至术后即刻26.0 cm,末次随访时为31.1 cm,平均增长率为1.05 cm/年.SAL术前平均0.81,术后即刻改善至0.84,末次随访时为0.92.其中有3例患者最终接受后路脊柱融合术;有3例患者发生共4例次并发症.双棒组30例患者一共施行159次手术,其中125次为撑开术,平均每例患者经历4.2次撑开术.冠状面主弯侧凸Cobb角术前平均72°±22°,术后即刻35°±14°,末次随访时35°±17°.T1 ~S1长度从术前(25 ±5) cm增至术后即刻的(29±5)cm,末次随访时为(33±5) cm,平均增长率为1.49 cm/年.SAL术前平均0.84±0.08,术后即刻改善至0.94±0.05,末次随访时为0.96±0.06;有3例最终接受后路脊柱融合术.在30例患者中,共有7例患者共发生13例次并发症,主要为内固定相关并发症.结论 生长棒技术治疗先天性脊柱侧凸是安全而有效的,该技术可以在维持矫形的同时,保留脊柱的生长潜力.生长棒技术需要多次手术,而且目前内固定相关并发症发生率较高.

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abstracts:

Objective To evaluate clinical outcomes of growing rod technique in treating young children with congenital scoliosis.Methods From August 2002 to October 2009,34 patients with congenital scoliosis underwent growing rod procedures including 12 male and 22 female patients.Four patients underwent posterior correction surgeries with single growing rod (single growing rod group),30 patients underwent posterior correction surgeries with dual growing rod(dual growing rod group).The average age at initial surgery was 6.9(2-13) years.Five patients with severe rigid deformity or kyphosis had an osteotomy at apex vertebra with short segmental fusion followed by dual growing rod technique.The analysis included age at initial surgery and final fusion (if applicable),number and frequency of lengthenings,and complications.Radiographic evaluation including scoliosis,trunk translation,length of T1-S1,thoracic kyphosis and lumbar lordosis was conducted.Results The follow-up was 40.5 (24-110) months.In single growing rod group,the mean scoliosis Cobb angle improved from 80.9°to 59.5°after initial surgery and was 65.3°at the latest follow-up.T1-S1 length increased from average 24.3 cm to 26.0 cm after initial surgery,and to 31.1 cm at latest follow-up with an increase of 1.05 cm per year.The space available for lung ratio (SAL) in patients with thoracic curves improved from 0.81 to 0.92 at the latest follow-up.Three patients reached final fusion.Four complications occurred in 3 of the 4 patients.In dual growing rod group,the mean scoliosis Cobb angle improved from 72° ± 22°to 35 ± 14° after initial surgery and was 35 ± 17°at the last follow-up or post-final fusion.T1-S1 length increased from (25 ± 5) cm to (29 ± 5) cm after initial surgery and to (33 ±5)cm at latest follow-up with an average T1-S1 length increase of 1.49 cm per year.The SAL in patients with thoracic curves improved from 0.84 ± 0.08 to 0.96 ± 0.06 at the latest follow-up.Three patients reached final fusion.Complications occurred in 7 of the 30 patients,and they had a total of 13 complications.Conclusions Growing rod technique is a safe and effective choice for young children of long,complex congenital scoliosis.It maintains correction achieved at initial surgery while allowing spinal growth to continue.Implants-related complications remain the biggest challenge.

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