单纯后路经肋横突孔单侧脊柱栓系治疗生长期脊柱侧弯的解剖和实验研究
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摘要
研究背景
青少年特发性脊柱侧弯(Adolescent Idiopathic Scoliosis, AIS)是青少年肌肉骨骼系统最常见的畸形之一，文献报道其发病率约为1-3%。目前对于这部分患者的治疗指南建议：对于侧弯50°以上的患者，进行脊柱融合术；而对于侧弯在25°到45°之间的患者，建议使用矫形支具治疗。脊柱融合术虽然能够矫正畸形，但是严重阻碍躯干和胸廓的发育，甚至危机患者心肺功能。而矫形支具只能延缓侧弯的发展，矫形作用不确定。而且，支具治疗存在着疗效不稳定和患者依从性差等问题。为了解决这个两难困境，近来有人提出使用脊柱非融合术，治疗生长期脊柱侧弯，目前使用的非融合方式主要有:前路椎体间骑缝钉，后路生长棒。但是，生长棒需要每半年一次手术，极大增加了手术和麻醉风险，以及并发症的发生。前路骑缝钉需要经前路开胸手术，内固定位置紧邻大血管，手术风险性高，且影响患者呼吸功能。鉴于目前非融合手术存在的问题，我们提出一种单纯后路，经肋横突孔单侧异体肌腱移植栓系，治疗生长期脊柱侧弯的手术方法。希望能够利用脊柱自身的生长发育达到矫正畸形的目的。
研究目的
通过幼猪侧弯模型，来研究单纯后路经肋横突孔，异体移植肌腱栓系，对脊柱生长调控，和矫正生长期脊柱侧弯的可行性和有效性，并通过Micro-CT和组织形态学初步探讨栓系的作用机制。另一方面，借助数字化人体平台和患者影像学资料库，从应用解剖和临床影像学等方面对拟手术区域-肋横突孔以及椎弓根-肋骨复合体进行系统研究，为这种方法的临床运用提供应用解剖学基础。
研究方法
本课题研究通过胸椎肋横突孔，单侧移植肌腱组织栓系，对于幼猪脊柱生长的调节作用。取8周大小健康约克夏猪17只，随机分为四组：空白对照组、单纯肌腱移植组、侧弯治疗组和侧弯未治疗组。空白组，不进行任何治疗，或肌腱移植操作，仅进行假手术操作；单纯肌腱移植组，仅进行后路异体肌腱移植；侧弯治疗组是指预先通过其他方法诱导实验动物出现Cobb角45-50度的脊柱侧弯，然后再进行后路肌腱移植的治疗手术；侧弯未治疗组是指同侧弯治疗组一同建立侧弯模型，但不进行治疗。四组动物手术后观察一定时间后处死，之后根据术前以及术后每月X线片，脊柱CT扫描，椎体Micro-CT和组织形态学表现，观察和评价单侧移植肌腱组织栓系对椎体的生长调控和侧弯矫正的效果并初步探讨机制。我们对上一部分，在动物实验中涉及到的手术区域，即肋横突孔和椎弓根-肋骨复合体，及其毗邻结构进行了系统的应用解剖学研究。利用我校数字人体数据集中，对3例可视化人体数据断面分割，三维重建胸段脊柱及毗邻结构，描述肋横突孔及椎弓根-肋骨复合体的解剖学特征，测量肋横突孔横截面大小，椎弓根-肋骨复合体横径、纵径、重合纵径，以及复合体区域内手术安全角，探讨肋横突孔及椎弓根-肋骨复合体的外科手术意义。随后，我们主要研究了原发性青少年脊柱侧弯（adolescent idiopathic scoliosis，AIS）患者的肋横突孔，以及椎弓根-肋骨复合体的形态学特征。回顾性分析了104例，2005年7月至2013年3月期间，于我院骨科行门诊，或术前CT扫描三维重建的AIS(右胸弯)患者影像学资料，和38例，2007年5月至2012年12月，在我院行CT检查但无脊柱畸形患者的资料，选取脊柱侧弯患者男49例，女75例；平均年龄10岁。Lenke分型：I型58例、Ⅲ型46例。主胸弯Cobb角平均为45.95°。正常对照组，男性15例，女性23例，平均年龄11岁。测量脊柱侧弯患者凸侧顶椎，以及上下相邻两个椎体的，肋横突孔横截面积，椎弓根-肋骨复合体和椎弓根横径并与正常对照组对比，分析AIS患者肋横突孔，椎弓根-肋骨复合体和椎弓根的形态学特点及影响因素。同时，我们通过对6例患者的2临床随访观察，进一步研究了单纯后路脊柱融合术对生长期脊柱的影响。
研究结果
动物手术16周后，与空白组和术前自身对比，单纯肌腱移植组动物，被诱导出三维结构性侧弯，伴有顶椎的楔形变，随后的Micro-CT和组织形态学结果，证明了肌腱栓系对椎体的生长调节作用。侧弯治疗组和未治疗组，所有动物，在侧弯诱导手术术后，出现一致的脊柱侧弯，在分别进行凸侧肌腱移植栓系，和空白手术后12周，治疗组脊柱侧弯程度，比治疗手术前，和未治疗组明显减轻；而侧弯未治疗组，治疗手术前后无显著变化。Micro-CT和组织形态学证实，单侧栓系，通过调节侧弯节段内椎体生长来矫正侧弯。对建立的数字化人体三维模型的解剖研究发现，椎弓根-肋骨复合体是三维立体结构，肋横突孔位于复合体内，肋横突孔内未走行任何重要神经血管结构，横截面随椎体水平下降而变小，肋横突孔可以作为放置内固定物的间隙；椎弓根-肋骨复合体横径明显大于椎弓根，但是有效纵径小于其横径；椎弓根-肋骨复合体区域手术安全角随水平变化较大，但有效工作范围恒定。影像学研究发现，侧弯组肋横突孔横截面积，明显大于正常组的对应节段面积。侧弯患者，主胸弯凹侧椎弓根横径明显小于凸侧，凹侧椎弓根一肋骨复合体横径明显大于凸侧；正常组左右侧椎弓根一肋骨复合体，以及椎弓根横径无显著差别；侧弯组顶椎，凹侧椎弓根横径明显小于正常组对应侧椎弓根横径；侧弯顶椎，凸侧椎弓根-肋骨复合体横径明显小于正常组对应横径；侧弯组，凹侧椎弓根横径明显小于正常组对应横径；除顶椎外，侧弯组，凹侧椎弓根-肋骨复合体横径均值大于正常组对应横径。正常组和侧弯组两侧椎弓根和椎弓根-肋骨复合体横径测量值均出现从头侧向尾侧逐渐增大的趋势。所有患者均完成至少2年随访，所有侧弯矫形保持良好，未发现有明显曲轴现象或肺功能不全。
研究结论
正常人群和年轻AIS患者肋横突孔和椎弓根-肋骨复合体内具有足够安全手术空间，单纯后路经过肋横突孔异体移植肌腱单侧脊柱栓系，可以调节脊柱的生长，从而矫正脊柱侧弯。这种手术方法，可能成为一种新型的治疗生长期脊柱侧弯的非融合手术方式。
Background: Adolescent idiopathic scoliosis (AIS) is one of the most commondeformities of the musculoskeletal system for young people. The incidence ranges from1%to3%. Spinal fusion is usually recommended for patient whose curve is greater than50°,and for those with curves between45°to25°, spinal bracing would be considered. However,the spinal fusion has several problems including restriction of the trunk height, limitation ofthe thoracic development and even compromise the pulmonary function. And the efficacyof bracing is not definite and could be compromised by poor compliances. Recently, thenon-fusion surgery for the treatment of immature scoliosis has been proposed, includinganterior vertebral staples and posterior growing rod. But the growing rod requires seriallengthening procedures before maturity and the anterior staples have to be put around majorvascular structures, both of which greatly increase the surgical risks and rate ofcomplications. We, therefore, propose a posterior only approach tethering procedure whichincludes implantation of an allograft tendon via the costo-transverse foramen. Our goal isthat this allograft tendon would be able to correct the spinal scoliosis by growth modulationwhile preserving the growth potential.
Objectives:
To investigate the feasibility and efficacy of spinal growth modulation and scoliosiscorrection with unilateral flexible tethering via the costo-transverse foramen on immatureporcine models, in addition, Micro-CT and histo-morphological analysis were done toillustrate the effects of tethering. On the other hand, based on the Chinese visible human(CVH) database and clinical radiology database of AIS, anatomical and radiological studywas done on the region of costo-transverse foramen and the pedicle-rib complex, whichfurther validated and supported the clinical application and feasibility of the tetheringprocedure.
Methods:
This IACUC-approved study included17eight weeks old immature Yorkshire pigs,which were randomized into four groups, including tendon tethering, sham operation,scoliosis treatment and scoliosis none treatment. In the initial study of tethering group andsham operation, scoliosis was induced using a previously harvested allograft tendoninserted as a tether into the costo-transverse foramen within the pedicle-rib complex.Afterwards, in the scoliosis treatment study, a first stage surgery was performed to initiate aspinal deformity by tethering the ribcage and spine. Serial radiographs were obtainedbi-weekly to confirm progression of spinal deformity. Once the animals had demonstrated aspinal deformity greater than45degrees, they underwent a second stage surgery of scoliosistreatment or sham treatment operations. For the treatment group a posterior convex sideallograft tendon tether was applied with a bone anchor in an effort to correct the deformityvia the costo-transvere foreman. For all four groups, the progression of deformity wasdocumented by monthly radiographs. Coronal, sagittal and axial changes were assessedusing the Cobb method, along with post mortem CT of the spines. In addition, Micro-CTand histo-morphological analysis were done to illustrate the effects of tendon tethering.Based on the CVH database, three dimensional model was generated to study theanatomical structures of costo-transverse foramen and the pedicle-rib complex. Parametersof the costo-transvere foramen and the pedicle rib-complex were measured as well. Thethree dimensional computered tomography(CT) data of104AIS patients(49males and75females, averaging10years old) who underwent CT examination in our institution fromJuly2005to March2013, and38matched normal people(15males and23females,averaging11years old) who underwent CT examination in our institution from May2007to December2012, were reviewed retrospectively to illustrate the morphologicalcharacteristics of the costo-transverse foramen and pedicle-rib complex. According to theLenke classification, there were58cases of Lenke I and46cases of Lenke III in the AISgroup. The average Cobb angles of the main thoraic curve was45.95degrees in the AISgroup. Based on the three dimensional reconstruction of CT data in Amira software, themorphological characteristics of the costo-transverse foramen and pedicle-rib complex indifferent levels were described and analyzed in both AIS and normal people. And comparisons were made within and between the AIS and normal people group. The possiblefactors contributing to the morphological changes in AIS patients were discussed andsummarized. In addition, the effects of posterior only spinal fusion surgery on immaturescoliosis spine were discussed in a clinical follow-up study.
Results:
The animals from tendon tethering and sham operation groups were observed for16weeks post-surgery. Significant three dimensional spinal deformities were induced in thetendon tethering group, compared to those of sham operation group. And the followingMicro-CT and histo-morphological analysis further illustrated the effects of the tether bythe demonstration of the changes within the vertebral trabecular and growth plates. In thescoliosis treatment study,12weeks after the second surgery, the deformities of thetreatment group were significantly smaller than those of none treatment group, and thescoliosis corrective and growth preserving effects of the tether were also interpreted by thefollowing Micro-CT and histo-morphological analysis. A three dimensional model of thecosto-transverse foramen and the pedicle-rib complex was generated. The anatomical studyproved that the pedicle-rib complex is a three dimensional structure, in whichcosto-transverse foramen is formed. The costo-transverse foramen varies among differentlevels, but all of them are large enough for tether placement. The sagittal effective diameterof the pedicle-rib complex is significantly smaller than that of the sagittal boundary of thecomplex. The safe zone within the pedicle-rib complex varies among levels, but theeffective ranges reached by approaches with the safe zones are consistent throughout alllevels. The cross sectional area of the costo-transverse foramen in AIS patients was largerthan those of normal matched people. The axial width of the pedicle-rib complex was largeron the concave side, and the pedicle was larger on the convex side. The axial width of thepedicle-rib complex on the concave side was smaller than that of normal matched people.The width of pedicle-rib complex of both groups were larger than those of pedicles, and allshowed the pattern of cranial to caudal decreasing. All patients were followed up for at least2years, the corrections were well maintained and there were no signs of crankshaft orrespiratory function defect.
Conclusion: With the placement of a unilateral allograft tendon spinal tether via thecosto-transverse foreman, a significant spinal deformity can be produced on normal spine and a significant scoliosis can be corrected by applying this tethering procedure.Furthermore, the anatomical study of the costo-transverse foramen and the pedicle-ribcomplex of both normal and AIS population supported the clinical feasibility of theprocedure. These data suggest that an allograft tendon tethering approach may represent anovel fusion-less procedure to treat idiopathic scoliosis in immature population.
青少年特发性脊柱侧弯(Adolescent Idiopathic Scoliosis, AIS)是青少年肌肉骨骼系统最常见的畸形之一，文献报道其发病率约为1-3%。目前对于这部分患者的治疗指南建议：对于侧弯50°以上的患者，进行脊柱融合术；而对于侧弯在25°到45°之间的患者，建议使用矫形支具治疗。脊柱融合术虽然能够矫正畸形，但是严重阻碍躯干和胸廓的发育，甚至危机患者心肺功能。而矫形支具只能延缓侧弯的发展，矫形作用不确定。而且，支具治疗存在着疗效不稳定和患者依从性差等问题。为了解决这个两难困境，近来有人提出使用脊柱非融合术，治疗生长期脊柱侧弯，目前使用的非融合方式主要有:前路椎体间骑缝钉，后路生长棒。但是，生长棒需要每半年一次手术，极大增加了手术和麻醉风险，以及并发症的发生。前路骑缝钉需要经前路开胸手术，内固定位置紧邻大血管，手术风险性高，且影响患者呼吸功能。鉴于目前非融合手术存在的问题，我们提出一种单纯后路，经肋横突孔单侧异体肌腱移植栓系，治疗生长期脊柱侧弯的手术方法。希望能够利用脊柱自身的生长发育达到矫正畸形的目的。
研究目的
通过幼猪侧弯模型，来研究单纯后路经肋横突孔，异体移植肌腱栓系，对脊柱生长调控，和矫正生长期脊柱侧弯的可行性和有效性，并通过Micro-CT和组织形态学初步探讨栓系的作用机制。另一方面，借助数字化人体平台和患者影像学资料库，从应用解剖和临床影像学等方面对拟手术区域-肋横突孔以及椎弓根-肋骨复合体进行系统研究，为这种方法的临床运用提供应用解剖学基础。
研究方法
本课题研究通过胸椎肋横突孔，单侧移植肌腱组织栓系，对于幼猪脊柱生长的调节作用。取8周大小健康约克夏猪17只，随机分为四组：空白对照组、单纯肌腱移植组、侧弯治疗组和侧弯未治疗组。空白组，不进行任何治疗，或肌腱移植操作，仅进行假手术操作；单纯肌腱移植组，仅进行后路异体肌腱移植；侧弯治疗组是指预先通过其他方法诱导实验动物出现Cobb角45-50度的脊柱侧弯，然后再进行后路肌腱移植的治疗手术；侧弯未治疗组是指同侧弯治疗组一同建立侧弯模型，但不进行治疗。四组动物手术后观察一定时间后处死，之后根据术前以及术后每月X线片，脊柱CT扫描，椎体Micro-CT和组织形态学表现，观察和评价单侧移植肌腱组织栓系对椎体的生长调控和侧弯矫正的效果并初步探讨机制。我们对上一部分，在动物实验中涉及到的手术区域，即肋横突孔和椎弓根-肋骨复合体，及其毗邻结构进行了系统的应用解剖学研究。利用我校数字人体数据集中，对3例可视化人体数据断面分割，三维重建胸段脊柱及毗邻结构，描述肋横突孔及椎弓根-肋骨复合体的解剖学特征，测量肋横突孔横截面大小，椎弓根-肋骨复合体横径、纵径、重合纵径，以及复合体区域内手术安全角，探讨肋横突孔及椎弓根-肋骨复合体的外科手术意义。随后，我们主要研究了原发性青少年脊柱侧弯（adolescent idiopathic scoliosis，AIS）患者的肋横突孔，以及椎弓根-肋骨复合体的形态学特征。回顾性分析了104例，2005年7月至2013年3月期间，于我院骨科行门诊，或术前CT扫描三维重建的AIS(右胸弯)患者影像学资料，和38例，2007年5月至2012年12月，在我院行CT检查但无脊柱畸形患者的资料，选取脊柱侧弯患者男49例，女75例；平均年龄10岁。Lenke分型：I型58例、Ⅲ型46例。主胸弯Cobb角平均为45.95°。正常对照组，男性15例，女性23例，平均年龄11岁。测量脊柱侧弯患者凸侧顶椎，以及上下相邻两个椎体的，肋横突孔横截面积，椎弓根-肋骨复合体和椎弓根横径并与正常对照组对比，分析AIS患者肋横突孔，椎弓根-肋骨复合体和椎弓根的形态学特点及影响因素。同时，我们通过对6例患者的2临床随访观察，进一步研究了单纯后路脊柱融合术对生长期脊柱的影响。
研究结果
动物手术16周后，与空白组和术前自身对比，单纯肌腱移植组动物，被诱导出三维结构性侧弯，伴有顶椎的楔形变，随后的Micro-CT和组织形态学结果，证明了肌腱栓系对椎体的生长调节作用。侧弯治疗组和未治疗组，所有动物，在侧弯诱导手术术后，出现一致的脊柱侧弯，在分别进行凸侧肌腱移植栓系，和空白手术后12周，治疗组脊柱侧弯程度，比治疗手术前，和未治疗组明显减轻；而侧弯未治疗组，治疗手术前后无显著变化。Micro-CT和组织形态学证实，单侧栓系，通过调节侧弯节段内椎体生长来矫正侧弯。对建立的数字化人体三维模型的解剖研究发现，椎弓根-肋骨复合体是三维立体结构，肋横突孔位于复合体内，肋横突孔内未走行任何重要神经血管结构，横截面随椎体水平下降而变小，肋横突孔可以作为放置内固定物的间隙；椎弓根-肋骨复合体横径明显大于椎弓根，但是有效纵径小于其横径；椎弓根-肋骨复合体区域手术安全角随水平变化较大，但有效工作范围恒定。影像学研究发现，侧弯组肋横突孔横截面积，明显大于正常组的对应节段面积。侧弯患者，主胸弯凹侧椎弓根横径明显小于凸侧，凹侧椎弓根一肋骨复合体横径明显大于凸侧；正常组左右侧椎弓根一肋骨复合体，以及椎弓根横径无显著差别；侧弯组顶椎，凹侧椎弓根横径明显小于正常组对应侧椎弓根横径；侧弯顶椎，凸侧椎弓根-肋骨复合体横径明显小于正常组对应横径；侧弯组，凹侧椎弓根横径明显小于正常组对应横径；除顶椎外，侧弯组，凹侧椎弓根-肋骨复合体横径均值大于正常组对应横径。正常组和侧弯组两侧椎弓根和椎弓根-肋骨复合体横径测量值均出现从头侧向尾侧逐渐增大的趋势。所有患者均完成至少2年随访，所有侧弯矫形保持良好，未发现有明显曲轴现象或肺功能不全。
研究结论
正常人群和年轻AIS患者肋横突孔和椎弓根-肋骨复合体内具有足够安全手术空间，单纯后路经过肋横突孔异体移植肌腱单侧脊柱栓系，可以调节脊柱的生长，从而矫正脊柱侧弯。这种手术方法，可能成为一种新型的治疗生长期脊柱侧弯的非融合手术方式。
Background: Adolescent idiopathic scoliosis (AIS) is one of the most commondeformities of the musculoskeletal system for young people. The incidence ranges from1%to3%. Spinal fusion is usually recommended for patient whose curve is greater than50°,and for those with curves between45°to25°, spinal bracing would be considered. However,the spinal fusion has several problems including restriction of the trunk height, limitation ofthe thoracic development and even compromise the pulmonary function. And the efficacyof bracing is not definite and could be compromised by poor compliances. Recently, thenon-fusion surgery for the treatment of immature scoliosis has been proposed, includinganterior vertebral staples and posterior growing rod. But the growing rod requires seriallengthening procedures before maturity and the anterior staples have to be put around majorvascular structures, both of which greatly increase the surgical risks and rate ofcomplications. We, therefore, propose a posterior only approach tethering procedure whichincludes implantation of an allograft tendon via the costo-transverse foramen. Our goal isthat this allograft tendon would be able to correct the spinal scoliosis by growth modulationwhile preserving the growth potential.
Objectives:
To investigate the feasibility and efficacy of spinal growth modulation and scoliosiscorrection with unilateral flexible tethering via the costo-transverse foramen on immatureporcine models, in addition, Micro-CT and histo-morphological analysis were done toillustrate the effects of tethering. On the other hand, based on the Chinese visible human(CVH) database and clinical radiology database of AIS, anatomical and radiological studywas done on the region of costo-transverse foramen and the pedicle-rib complex, whichfurther validated and supported the clinical application and feasibility of the tetheringprocedure.
Methods:
This IACUC-approved study included17eight weeks old immature Yorkshire pigs,which were randomized into four groups, including tendon tethering, sham operation,scoliosis treatment and scoliosis none treatment. In the initial study of tethering group andsham operation, scoliosis was induced using a previously harvested allograft tendoninserted as a tether into the costo-transverse foramen within the pedicle-rib complex.Afterwards, in the scoliosis treatment study, a first stage surgery was performed to initiate aspinal deformity by tethering the ribcage and spine. Serial radiographs were obtainedbi-weekly to confirm progression of spinal deformity. Once the animals had demonstrated aspinal deformity greater than45degrees, they underwent a second stage surgery of scoliosistreatment or sham treatment operations. For the treatment group a posterior convex sideallograft tendon tether was applied with a bone anchor in an effort to correct the deformityvia the costo-transvere foreman. For all four groups, the progression of deformity wasdocumented by monthly radiographs. Coronal, sagittal and axial changes were assessedusing the Cobb method, along with post mortem CT of the spines. In addition, Micro-CTand histo-morphological analysis were done to illustrate the effects of tendon tethering.Based on the CVH database, three dimensional model was generated to study theanatomical structures of costo-transverse foramen and the pedicle-rib complex. Parametersof the costo-transvere foramen and the pedicle rib-complex were measured as well. Thethree dimensional computered tomography(CT) data of104AIS patients(49males and75females, averaging10years old) who underwent CT examination in our institution fromJuly2005to March2013, and38matched normal people(15males and23females,averaging11years old) who underwent CT examination in our institution from May2007to December2012, were reviewed retrospectively to illustrate the morphologicalcharacteristics of the costo-transverse foramen and pedicle-rib complex. According to theLenke classification, there were58cases of Lenke I and46cases of Lenke III in the AISgroup. The average Cobb angles of the main thoraic curve was45.95degrees in the AISgroup. Based on the three dimensional reconstruction of CT data in Amira software, themorphological characteristics of the costo-transverse foramen and pedicle-rib complex indifferent levels were described and analyzed in both AIS and normal people. And comparisons were made within and between the AIS and normal people group. The possiblefactors contributing to the morphological changes in AIS patients were discussed andsummarized. In addition, the effects of posterior only spinal fusion surgery on immaturescoliosis spine were discussed in a clinical follow-up study.
Results:
The animals from tendon tethering and sham operation groups were observed for16weeks post-surgery. Significant three dimensional spinal deformities were induced in thetendon tethering group, compared to those of sham operation group. And the followingMicro-CT and histo-morphological analysis further illustrated the effects of the tether bythe demonstration of the changes within the vertebral trabecular and growth plates. In thescoliosis treatment study,12weeks after the second surgery, the deformities of thetreatment group were significantly smaller than those of none treatment group, and thescoliosis corrective and growth preserving effects of the tether were also interpreted by thefollowing Micro-CT and histo-morphological analysis. A three dimensional model of thecosto-transverse foramen and the pedicle-rib complex was generated. The anatomical studyproved that the pedicle-rib complex is a three dimensional structure, in whichcosto-transverse foramen is formed. The costo-transverse foramen varies among differentlevels, but all of them are large enough for tether placement. The sagittal effective diameterof the pedicle-rib complex is significantly smaller than that of the sagittal boundary of thecomplex. The safe zone within the pedicle-rib complex varies among levels, but theeffective ranges reached by approaches with the safe zones are consistent throughout alllevels. The cross sectional area of the costo-transverse foramen in AIS patients was largerthan those of normal matched people. The axial width of the pedicle-rib complex was largeron the concave side, and the pedicle was larger on the convex side. The axial width of thepedicle-rib complex on the concave side was smaller than that of normal matched people.The width of pedicle-rib complex of both groups were larger than those of pedicles, and allshowed the pattern of cranial to caudal decreasing. All patients were followed up for at least2years, the corrections were well maintained and there were no signs of crankshaft orrespiratory function defect.
Conclusion: With the placement of a unilateral allograft tendon spinal tether via thecosto-transverse foreman, a significant spinal deformity can be produced on normal spine and a significant scoliosis can be corrected by applying this tethering procedure.Furthermore, the anatomical study of the costo-transverse foramen and the pedicle-ribcomplex of both normal and AIS population supported the clinical feasibility of theprocedure. These data suggest that an allograft tendon tethering approach may represent anovel fusion-less procedure to treat idiopathic scoliosis in immature population.
引文
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1Akbarnia BA, Blakemore LC, Campbell RM, Jr., Dormans JP. Approaches for the very young child with spinaldeformity: what's new and what works. Instructional course lectures.2009;59:407-424.
2Newton PO, Farnsworth CL, Faro FD, Mahar AT, Odell TR, Mohamad F, et al. Spinal growth modulation with ananterolateral flexible tether in an immature bovine model: disc health and motion preservation. Spine.2008;33(7):724-733.
3Braun JT, Akyuz E, Ogilvie JW, Bachus KN. The efficacy and integrity of shape memory alloy staples and boneanchors with ligament tethers in the fusionless treatment of experimental scoliosis. The Journal of bone and joint surgery.2005;87(9):2038-2051.
4Newton PO, Farnsworth CL, Upasani VV, Chambers RC, Varley E, Tsutsui S. Effects of intraoperative tensioning of ananterolateral spinal tether on spinal growth modulation in a porcine model. Spine.2011;36(2):109-117.
5Zhang H, Sucato DJ. Unilateral pedicle screw epiphysiodesis of the neurocentral synchondrosis. Production ofidiopathic-like scoliosis in an immature animal model. The Journal of bone and joint surgery.2008;90(11):2460-2469
6Moal B, Schwab F, Demakakos J, Lafage R, Riviere P, Patel A, et al. The impact of a corrective tether on a scoliosisporcine model: a detailed3D analysis with a20weeks follow-up. Eur Spine J.22(8):1800-1809.
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4Newton PO, Farnsworth CL, Upasani VV, Chambers RC, Varley E, Tsutsui S. Effects of intraoperative tensioning of ananterolateral spinal tether on spinal growth modulation in a porcine model. Spine.2011;36(2):109-117.
5Moal B, Schwab F, Demakakos J, Lafage R, Riviere P, Patel A, et al. The impact of a corrective tether on a scoliosis
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1Zhang H, Sucato DJ. Unilateral pedicle screw epiphysiodesis of the neurocentral synchondrosis. Production ofidiopathic-like scoliosis in an immature animal model. The Journal of bone and joint surgery.2008;90(11):2460-2469.
1Hresko MT. Clinical practice. Idiopathic scoliosis in adolescents. The New England journal of medicine.2013;368(9):834-841.
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4Akel I, Yazici M. Growth modulation in the management of growing spine deformities. Journal of children'sorthopaedics.2009;3(1):1-9.
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3Braun JT, Akyuz E, Ogilvie JW, Bachus KN. The efficacy and integrity of shape memory alloy staples and boneanchors with ligament tethers in the fusionless treatment of experimental scoliosis. The Journal of bone and joint surgery.2005;87(9):2038-2051.
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