摘要目的 探讨后凸型早发性脊柱侧凸(early-onset scoliosis,EOS)在生长棒治疗期间的脊柱矢状面参数改变以及并发症情况.方法 收集2009年11月至2016年11月在我科接受生长棒技术治疗的32例EOS患者,所有患者均经2次以上撑开手术以及2年以上随访,其中男8例,女24例.根据正常儿童T2-12胸椎后凸角(thoracic kyphosis,TK)参考值分为正常后凸组(TK为20°～50°,15例,男4例,女11例)和过度后凸组(TK＞ 50°,17例,男4例,女13例),两组的病因学构成比相似,术前平均年龄分别为(6.2±2.0)岁和(6.3±2.3)岁,脊柱侧凸柔韧度分别为34.6％±10.4％和35.8％±11.2％.术中将预弯好的钛棒穿过深筋膜下方肌肉,分别与近端、远端锚定点、连接阀或多米诺连接器相连,适当撑开后两端锁紧,并将生长阀或多米诺连接器植于胸腰段深筋膜下.结果 正常后凸组和过度后凸组随访时间分别为(5.5±1.9)年和(5.5±2.1)年.正常后凸组和过度后凸组的近端及远端固定椎体分布相似,平均撑开次数分别为(5.1±2.0)次和(5.3±2.3)次,撑开间隔时间分别为(11.3±2.3)个月和(10.9±1.9)个月.正常后凸组的TK由术前36.0°±9.4°减至术后的30.6°±8.3°,末次随访时为32.2°±7.8°,均维持在正常范围内;过度后凸组的TK由67.6°±11.6°减至41.7°±8.7°,差异有统计学意义,矫正率为38.3％±14.6％,末次随访时轻度增至46.5°±8.4°,与术后相比差异无统计学意义,矫正丢失率为7.1％±4.2％.并发症发生率:过度后凸组(33.3％)高于正常后凸组(76.5％),差异有统计学意义.最常见的内固定相关和矢状面形态相关并发症分别是断棒(15.6％)和近端交界性后凸(proximal junctional kyphosis,PJK,21.9％),正常后凸组和过度后凸组的断棒率分别为6.7％和23.5％,PJK发生率分别为13.3％和29.4％.过度后凸组PJA在术前、术后及末次随访时均高于正常后凸组,且随访期间的增长值明显大于正常后凸组(1.6°±1.0°vs.0.7°±0.8°),差异有统计学意义.并发症分级:Ⅰ级,正常后凸组4例次,过度后凸组7例次;ⅡA级,正常后凸组4例次,过度后凸组7例次.结论 生长棒技术可有效重建后凸型EOS的矢状面平衡,但并发症发生率较正常后凸对照组高.

abstractsObjective To evaluate the changes in sagittal profiles and complications during treatment with growing rods (GRs) in hyperkyphotic early-onset scoliosis (EOS).Methods From December 2009 to December 2016,a total of 32 EOS patients who received growing rods treatment in our center,including 8 males and 24 females,were reviewed retrospectively.All the patients had minimum 2-year follow-up and over 2 lengthenings.Based on the reference value of thoracic kyphosis (TK) in T2-12 of normal children,the patients were categorized into an N group (20°≤TK≤50°,15 cases,4 males and 11 females) or K group (TK≥50°,17 cases,4 males and 13 females).The distribution of etiology was similar between the two groups.The average age was (6.2±2.0) years and (6.3±2.3) years respectively,curve flexibility was 34.6％± 10.4％ and 35.8％± 11.2％ before surgery.The precontoured rods were tunneled submuscularly,connecting proximal and distal anchors,and tandem or domino connectors.The rods were then locked after applying direct distraction that allowed appropriate elongation.The connectors were all placed under the deep fascia.Results The mean follow-up in the N and K groups was (5.5±1.9) years and (5.5±2.1) years,respectively.The distribution of proximal and distal anchors was similar between the two groups.The N and K groups,respectively,had an average number of lengthenings of 5.1±2.0 and 5.3±2.3,with mean lengthening intervals of (11.3±2.3) months and (10.9±1.9) months,respectively.In the N group,TK was decreased from 36.0°±9.4° to 30.6°±.8.3° after surgery,and to 32.2°±7.8° at the last follow-up,demonstrating it was maintained within the normal range.In the K group,TK was markedly reduced from 67.6°±11.6° to 41.7°±8.7° after the index surgery,with a correction rate of 38.3％± 14.6％,and the difference was statistically significant.And then it slightly increased to 46.5°±8.4° at the last follow-up,with correction loss of 7.1％±4.2％,and the difference was not statistically significant compared with the postoperatiom.The complication rate in the K group was significantly higher than in the N group (76.5％ vs.33.3％,P=0.031).The most common implant-and alignment-related complication in both groups was rod fracture (15.6％) and proximal junctional kyphosis (21.9％),respectively.The incidence of rod fracture in the N group and K group was 6.7％ and 23.5％,respectively.And the incidence of proximal junctional kyphosis was noted as 13.3％ and 29.4％ in the N group and K group,respectively.Proximal junctional angle (PJA) in the K group was greater than that in the N group preoperatively,postoperatively and at the last follow-up.Moreover,the increasing amount of PJA was significantly greater in the K group compared to the N group (1.6°± 1.0° vs.0.7°±0.8°).Four and seven complication events in the N and K groups,respectively,were evaluated with Grade Ⅰ.Four and seven complication events in the N and K groups,respectively,were classified as Grade Ⅱ A.Conclusion GRs can effectively restore the sagittal profile in hyperkyphotie EOS patients,but with a higher complication rate compared to the patients with normal kyphosis.