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混合型生长棒与传统型生长棒技术治疗早发型先天性脊柱侧凸疗效对比

Comparison of hybrid and traditional growing rod techniques in the treatment of early-onset congenital scoliosis

摘要:

目的 比较混合型生长棒技术与传统型生长棒技术治疗早发型先天性脊柱侧凸畸形的矫形效果.方法 对南京大学医学院附属鼓楼医院脊柱外科应用混合型生长棒技术(混合型组)与传统型生长棒技术(传统型组)治疗的早发型先天性脊柱侧凸患者的临床资料进行回顾性对比研究.混合型组患者13例,男性5例,女性8例,初次手术年龄(5.6±2.8)岁;传统型组患者13例,男性6例,女性7例,初次手术年龄(6.1±3.0)岁.所有患者均经>2次撑开手术和≥2年随访;术前、术后即刻及末次随访时分别在X线片上测量相关影像学资料.术前、术后和末次随访时各参数采用配对样本t检验进行比较;两组患者的组间数据采用独立样本t检验进行比较.结果 混合型组随访时间(42.2±13.4)个月(范围:27~ 81个月),撑开次数为(4.0±1.8)次,撑开间隔时间为(10.5±1.0)个月;传统型组随访时间(45.4±15.2)个月(范围:24~ 76个月),撑开次数为(4.2±1.9)次,撑开间隔时间(10.8±1.1)个月.生长棒置入术后,两组患者主弯Cobb角、顶椎偏移距离、C7偏移距离及胸椎后凸角较术前均明显改善,而混合型组主弯Cobb角矫正率和胸椎后凸角矫正率均显著高于传统型组(分别为t=2.348,P=0.027和t=3.768,P<0.001);末次随访时,混合型组主弯Cobb角显著低于传统型组(t=2.790,P=0.010).生长棒置入术后,混昆合型组初次术后T1~S1平均撑开高度显著高于传统型组(t=2.846,P=0.008);随访过程中,混合型组和传统型组患者T1~S1平均生长速率相近(t=0.516,P=0.610).共有9例患者发生了10次术后并发症,其中混合型组2例,并发症分别为断棒和近端交界性后凸(PJK);传统型组7例,并发症分别为断棒(2例3次)、PJK(4例)、伤口感染(1例).结论 混合型生长棒较传统型生长棒可以在初次手术时更好地矫正脊柱侧后凸畸形,同时有效降低术后内固定并发症发生率;顶椎区短节段固定融合对脊柱的纵向生长无显著影响.

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abstracts:

Objective To compare the surgical outcomes between hybrid and traditional growing rod (GR) techniques in the treatment of early-onset congenital scoliosis (C-EOS).Methods A review was conducted of C-EOS patients who had undergone hybrid GR treatment at Department of Spine Surgery,the Affiliated Drum Tower Hospital of Nanjing University Medical School.Another group of patients who had undergone traditional GR were well matched to the hybrid GR group at a 1:1 ratio in terms of main Cobb angle,age at initial surgery,and lengthening numbers.There were 5 boys and 8 girls with an age of (5.6± 2.8) years in the hybrid GR group,and 6 boys and 8 girls with an age of (6.1±3.0) years in the traditional GR group,respectively.All patients had minimum 2-year follow-up and over 2 lengthening procedures.Radiographic data were compared with paired t tests in either group between each visit,and with independent t tests between the two groups.Results On average,the hybrid group had a follow-up of (42.2±13.4) months (range:27-81 months),and had (4.0±1.8) lengthening procedures with a lengthening interval of (10.5±1.0) months;and the traditioual GR group had a follow-up of (45.4±15.2) months (range:24-76 months),and experienced (4.2± 1.9) lengthenings with an interval of (10.8± 1.1) months.After the index surgery,the major Cobb angle,C7 translation,apical vertebral translation,and thoracic kyphosis (TK) had remarkable improvement in both groups.Notably,the hybrid GR group had significantly higher correction rates of major Cobb angle (t=2.348,P=0.027) and TK (t=3.768,P<0.001) than the traditional GR group.At the latest follow-up,the hybrid GR group had remarkably smaller Cobb angle of the major curve than the traditional GR group (t=2.790,P=0.010).At the same time,the hybrid GR group had higher T1-S1 height gain than the traditional GR group (t=2.846,P=0.008) after the index surgery.Whereas,non-significant difference was noted between two groups with regards to the T1-S1 growth rate during follow-up (t=0.516,P=0.610).Ten complications occurred during the follow-up period,including 2 in the hybrid GR group and 8 in the traditional GR group.The incidence of rod breakage and PJK in the traditional group was 3 and 4 times as high as that of the hybrid GR group,respectively.Conclusions The hybrid growing rod can not only help to improve the correction of spinal deformity but also decrease postoperative complications during follow-up.Moreover,apical short fusion shows no significant influence on spinal growth.

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作者: 孙旭 [1] 徐亮 [1] 陈忠辉 [1] 陈曦 [1] 刘臻 [1] 俞杨 [1] 钱邦平 [1] 王斌 [1] 邱勇 [1] 朱泽章 [1]
第一作者: 孙旭
期刊: 《中华外科杂志》2019年57卷5期 342-347页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2019.05.005
发布时间: 2019-06-06
基金项目:
National Natural Science Foundation of China Social Development Foundation of Jiangsu Province (BE2017606)国家自然科学基金资助项目面上项目 江苏省社会发展基金资助项目面上项目
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