生长棒联合顶椎控制技术治疗先天性早发性脊柱侧凸的毕业疗效  

The Performance of Graduation from Traditional Growing Rods with Apical Control Technique in Patients with Congenital Early⁃Onset Scoliosis

作　　者：李芷仪 赵钇伟 杜悠 李晨恺 张浩然 林莞锋 杨阳 叶笑寒 王升儒 仉建国 LI Zhiyi;ZHAO Yiwei;DU You;LI Chenkai;ZHANG Haoran;LIN Guanfeng;YANG Yang;YE Xiaohan;WANG Shengru;ZHANG Jianguo(Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Orthopaedic Surgery,Beijing Key Laboratory for Genetic Research of Skeletal Deformity,Key Laboratory of Big Data for Spinal Deformities,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;State Key Laboratory of Complex Severe and Rare Diseases,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院,北京100730 [2]中国医学科学院北京协和医院骨科,骨骼畸形遗传学研究北京市重点实验室,中国医学科学院脊柱畸形大数据研究与应用重点实验室,北京100730 [3]中国医学科学院北京协和医院,疑难重症及罕见病全国重点实验室,北京100730

出　　处：《罕见病研究》2023年第4期529-538,共10页Journal of Rare Diseases

基　　金：国家自然科学基金(82172382,81972037);中央高水平医院临床科研业务费(2022⁃PUMCH⁃B⁃122)。

摘　　要：目的先天性早发性脊柱侧凸(CEOS)的特征是一系列椎体形态异常,包括椎体形成障碍和分节不良,这使得CEOS与其他病因引起的早发性脊柱侧凸(EOS)在治疗结局上有所不同。迄今为止,关于传统生长棒(TGR)治疗CEOS的研究较少,更缺乏随访至“毕业”的研究。现有研究对于顶椎控制技术(ACT)的临床疗效报道不一。因此,本研究对比传统双生长棒与双生长棒联合ACT在CEOS患者中的临床效果。方法本研究回顾性分析2007年1月至2020年12月生长棒技术毕业的CEOS患者。毕业方式包括行最终融合手术或保留内固定继续观察。根据TGR是否联合ACT技术分为ACT-TGR组(全椎体切除术/半椎体切除术+短节段融合固定术联合TGR)和TGR组。分析人口统计学特征、影像学数据和并发症。结果本研究入组46例CEOS患者,其中ACT-TGR组13例,TGR组有33例。ACT-TGR组的撑开间期更长(中位数为117年vs 075年)。ACT-TGR组术前主弯度数较大[8700(6350,9800)],而在末次随访时两组残余弯度数具备可比性(P=0354)。末次随访时,两组患者的T1-T12和T1-S1高度相当。ACT-TGR组患者人均内固定相关并发症发生数量较低(077 vs 148)。ACT-TGR组中有3例患者接受最终融合,而TGR组中有17例患者接受最终融合(P=0060)。结论ACT-TGR和传统TGR均可有效矫正畸形,同时保留CEOS患者的脊柱生长。ACT-TGR对畸形严重的患者有更好的矫形作用,且对脊柱高度无明显影响。对于矫形效果可、自发融合且无内固定失败的患者,保留内固定继续观察可作为生长棒治疗至毕业的策略。Objective Different from other etiologies of early-onset scoliosis(EOS),congenital early-onset scoliosis(CEOS)is mainly linked to vertebral anomalies,such as formation failures and segmentation failures at the apex segments.So far,there is little research on CEOS patients who have completed traditional growing rods(TGR)treatment,and the initial outcomes of TGR with or without apical control technique(ACT)are different.Therefore,we compared the“final”results of CEOS patients who completed TGR treat-ment with or without ACT.Methods We conducted a retrospective study of CEOS patients who completed TGR treatment from 2007—2020.They either had final fusion or were followed up after reaching skeletal matu-rity.We split the patients into two groups based on whether they had ACT with TGR or not.The ACT-TGR group had apical vertebrectomy/hemivertebrectomy with short fusion and TGR.The TGR-only group had only TGR.We looked at their demographic features,radiographic measurements,and complications.Results This study enrolled 46 CEOS patients,of which 13 patients were in the ACT-TGR group and 33 patients in the TGR group.The ACT-TGR group had a longer distraction interval(117 years vs 075 years).The ACT-TGR group had a larger preoperative main curve[8700(6350,9800)],but the residual curve degrees were comparable between the two groups at the last follow-up(P=0354).At the last follow-up,the T1-12 and T1-S1 heights were similar between the two groups.The ACT-TGR group had a lower number of implant-related complications per patient(077 vs 148).Three patients in the ACT-TGR group underwent final fusion,while 17 patients in the TGR group underwent final fusion(P=0060).Conclusions Both ACT-TGR and traditional TGR coud effectively correct deformity and preserve spinal growth in CEOS patients.ACT-TGR had a better corrective effect on patients with severe deformity and did not have a significant impact on spinal height.For patients with acceptable correction,spontaneous fusion and without implant failure,retaining the implant an

关 键 词：早发性脊柱侧凸 传统生长棒 顶椎控制技术 混合技术 毕业疗效 

分 类 号：R687.3[医药卫生—骨科学]