纵向可撑开型人工钛肋技术治疗早发性脊柱侧凸早期疗效  

Early outcome of vertical expandable prosthetic titanium rib technique in treating early-onset scoliosis

作　　者：邱勇[1] 孙旭[1] 王斌[1] 丁旗[1] 朱泽章[1] 钱邦平[1] 俞杨[1] 朱锋[1] 马薇薇[1] 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华外科杂志》2012年第10期883-888,共6页Chinese Journal of Surgery

基　　金：基金项目：教育部中央高校基本科研业务费专项资金资助项目（021414340019）;江苏省自然科学基金创新学者攀登项目（BK2009001）

摘　　要：目的探讨纵向可撑开型人工钛肋技术（VEPTR）治疗早发性脊柱侧凸（EOS）的早期疗效。方法本组共入选11例自2006年12月至2011年7月行VEPTR技术治疗的EOS患者。男性8例，女性3例，初次手术时年龄3．1～9．8岁，平均（7±3）岁。在初次手术时放置VEPTR器械，使用肋骨-肋骨连接和肋骨-腰椎连接。术后每6～12个月行撑开延长术1次。测量并比较术前、术后和末次随访时主弯Cobb角、顶椎偏移、胸椎高度和T1～S1高度。采用配对t检验比较患者初次术前、初次术后和末次随访影像学测量结果，以评估手术疗效。结果初次手术后随访12—52个月，平均（32±11）个月。全部患者共接受手术41次，平均3．7次／例；共进行VEPTR撑开延长手术30次，平均2．7次／例。本组患者平均8个月行撑开延长1次。从术前到末次随访，主弯Cobb角从78°±18°减少到55°±11°（t=4．931，P〈0．05），顶椎偏移和胸椎后凸角在初次术后明显减小，随访时又有轻度增大。胸椎高度从（13．3±2．0）cm增加到（17．2±2．4）cm（t=8．365，P〈0．001），T1-S1高度从（24．4±3．8）cm增加到（32．5±5．3）cm（t=9．080，P〈0．001）。末次随访时与初次置入VEPTR术前相比，胸椎高度和T1～S1高度分别增加（4．0±1．3）cm和（8．1±2．6）cm。置入VEPTR术后，平均每次撑开术后胸椎高度和T1-S1高度分别可增加（0．8±0．3）cm和（1．8±0．4）cm。本组中有6例（共8例次）发生术中和（或）术后并发症，包括肋骨抱钩移位、迟发性感染、术中胸膜破裂和腰椎螺钉松动。结论VEPTR技术可有效控制EOS患者脊柱侧凸畸形的进展，并能保持脊柱和胸廓的生长，可作为EOS治疗的有效方法。由于手术相关并发症发生率较高，临床需要严格控制适应证。Objective To investigate the early outcome of vertical expandable prosthetic titanium rib （VEPTR） technique in treating early-onset scoliosis. Methods This study recruited 11 early-onset scoliosis patients （8 boys and 3 girls） who received YEPTR treatment from December 2006 to July 2011 with a minimum follow-up of 12 months. The average age at initial surgery was （7 ±3） years （range, 3.1 to 9. 8 years）. VEPTR device, either rib to rib or rib to lumbar, was implanted at initial surgery. During the regular post-operative follow-ups, expansion surgeries were scheduled at an interval of 6 to 12 months. Measurements of primary curve magnitude, apical vertebral translation, thoracic height and Tl -S1 height were performed on radiographs, and were compared between those of preoperatively, postoperatively, and at latest follow-up through paired-t tests. Results All patients had a mean follow-up of （32 ± 11 ） months. Totally 41 surgeries were performed, averagely 3.7 surgeries per patient; and 30 expansion surgeries were carried out, averagely 2. 7 surgeries per patient. The average interval for each expansion surgery was 8 months. From preoperatively to latest follow-up, the Cobb angle of primary curves was averagely corrected from 78° ± 18° to 55±11°（t = 4. 931, P 〈 0. 05 ）, and apical vertebral translation and thoracic kyphosis displayed slight improvement. Average thoracic height increased from （ 13.3 -± 2.0 ） cm to （ 17.2 ± 2.4 ） cm （ t = 8.365,P〈0.001）, and average T1-S1 height from （24.4 ±3.8）cm to （32.5 ±5.3）cm（t =9.080, P 〈0. 001 ）. After initial surgery with VEPTR instrumented, gains in thoracic height and T1-S1 height per expansion surgery averaged （0. 8 ± 0. 5 ） cm and （ 1.8 ± 0. 4） cm, respectively. Eight complications occurred in 6 patients, including rib cradle dislodgements, displayed infection, intraoperative pleura rupture and loosening of lumbar pedicle screws. Conclusions VEPTR technique proves to be an effective way of preventi

关 键 词：脊柱侧凸 钛 肋骨 假体和植入物 矫形外科手术 手术后并发症 

分 类 号：R687.3[医药卫生—骨科学]