钴铬钼多向滑动生长棒技术治疗Ⅰ型神经纤维瘤病性早发性脊柱侧凸  

Co-Cr-Mo guided multidirectional sliding growing rod technology for the treatment of type I neurofibromatosis induced early-onset scoliosis

作　　者：朱峰 梅伟 岳煜 马鸿杰[1] 孟长涛 蔡东良 宋相建 Zhu Feng;Mei Wei;Yue Yu;Ma Hongjie;Meng Changtao;Cai Dongliang;Song Xiangjian(Department of Scoliosis,Zhengzhou Orthopedic Hospital Affiliated to Henan University,Zhengzhou 450000,China)

机构地区：[1]河南大学附属郑州市骨科医院脊柱侧弯科,郑州450000

出　　处：《中华骨科杂志》2025年第7期402-411,共10页Chinese Journal of Orthopaedics

基　　金：河南省医学科技攻关计划项目(LHGJ20210792)。

摘　　要：目的探讨钴铬钼多向滑动生长棒(Co-Cr-Mo guided multidirectional sliding growing rod technology,CMSG)技术治疗Ⅰ型神经纤维瘤病营养不良型早发性脊柱侧凸的临床疗效。方法回顾性分析2010年1月至2022年7月于河南大学附属郑州市骨科医院手术治疗的20例Ⅰ型神经纤维瘤病营养不良型早发性脊柱侧凸患者资料,所有患者年龄≤10岁,Cobb角≥45°。采用传统生长棒(traditional growing-rod,TGR)手术治疗(TGR组)10例;采用CMSG技术治疗(CMSG组)10例。记录手术次数及并发症发生情况,测量侧凸主弯Cobb角、T_(5)~T_(12)后凸Cobb角、T_(1)~S_(1)高度,评价畸形矫正及脊柱生长情况。结果CMSG组与TGR组年龄、性别、随访时间、术前Cobb角、术前T_(5)~T_(12)后凸Cobb角比较差异均无统计学意义(P>0.05)。CMSG组手术次数为(1.30±0.67)次、总体医疗费用为(9.11±3.47)万元,低于TGR组的(5.30±1.77)次和(15.58±4.59)万元,差异有统计学意义(t=6.687,P<0.001;t=3.558,P=0.002)。CMSG组术前、初次术后、末次随访时的主弯Cobb角分别为69.7°±17.8°、19.8°±9.7°、24.4°±9.0°,TGR组分别为62.0°±11.1°、32.1°±11.4°、33.3°±11.6°,初次术后和末次随访时的组间差异有统计学意义(t=2.633,P=0.017;t=2.313,P=0.033)。CMSG组术前、初次术后、末次随访时的T_(5)~T_(12)胸椎后凸Cobb角为40.0°±24.2°、21.0°±6.0°、33.6°±9.3°,TGR组分别为31.3°±14.5°、26.3°±10.5°、32.3°±17.2°,初次术后和末次随访时的组间差异无统计学意义(P>0.05)。CMSG组术前、初次术后、末次随访时的T_(1)~S_(1)高度为(30.5±3.4)、(33.7±3.3)、(37.9±4.8)cm,每年增长(1.18±0.39)cm,TGR组分别为(29.1±3.0)、(31.4±2.9)、(36.3±3.5)cm,每年增长(1.25±0.23)cm,两组T_(1)~S_(1)高度年增长高度的差异无统计学意义(P>0.05)。随访期间CMSG组3例发生3例次并发症,冠状面躯干失代偿1例、断棒1例、远端交界性后凸1例;TGR组7例发生8例次并发症,切口破溃Objective To explore the differences in clinical efficacy between Co-Cr-Mo guided multidirectional sliding growing rod technology(CMSG)and traditional growing rod in the treatment of neurofibromatosis type 1 dysplastic early-onset scoliosis.Methods A retrospective analysis was conducted on the data of 20 patients with neurofibromatosis type 1 dysplastic early-onset scoliosis who underwent surgical treatment in the Scoliosis Department of Zhengzhou Orthopaedic Hospital Affiliated to Henan University from January 2010 to July 2022.There were 10 patients in the traditional rod group(treated with traditional growing rod surgery)and 10 patients in the CMSG group(treated with CMSG technology).All patients were≤10 years old and had a Cobb angle≥45°.The number of surgeries and the occurrence of complications were recorded.The Cobb angle of the main scoliotic curve,the Cobb angle of kyphosis from T_(5) to T_(12),and the height from T_(1) to S_(1) were measured from the imaging data to evaluate the correction of deformity and spinal growth.Results There were no significant differences in age,gender,follow-up time,preoperative Cobb angle,and preoperative Cobb angle of kyphosis from T_(5)-T_(12) between the CMSG group and the TGR group(P>0.05).The number of surgeries 1.3±0.67 and the total medical cost 91,100±34,700 yuan in the CMSG group were lower than those in the TGR group(5.3±1.77 times and 155,800±45,900 yuan),and the differences were statistically significant(t=6.687,P<0.001;t=3.558,P=0.002).The Cobb angles of the main curve before surgery,after the first surgery,and at the last follow-up in the CMSG group were 69.7°±17.8°,19.8°±9.7°,and 24.4°±9.0°respectively,while those in the TGR group were 62.0°±11.1°,32.1°±11.4°,and 33.3°±11.6°respectively.The differences in Cobb angles after the first surgery and at the last follow-up between the two groups were statistically significant(t=2.633,P=0.017;t=2.313,P=0.033).The Cobb angles of kyphosis from T_(5) to T_(12) before surgery,after the first sur

关 键 词：神经纤维瘤病1型 脊柱侧凸 生长和发育 营养不良型 钴铬钼 

分 类 号：R726.8[医药卫生—儿科]