多段小切口生长棒治疗儿童特发性脊柱侧凸
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摘要
[目的]评估微创多节段小切口滑槽钉生长棒治疗儿童脊柱侧弯的临床疗效。[方法]2014年1月~2017年7月,采用微创多节段小切口滑槽钉生长棒治疗特发性脊柱侧凸患儿8例[男3例,女5例,年龄(7.75±1.47)岁],并与同期14例行传统后路切口滑槽钉生长棒治疗的脊柱侧凸患儿[男4例,女10例,年龄(7.57±1.71)岁]进行对比。比较两组手术前后冠状位、矢状位Cobb角及其矫正率、切口长度、出血量、手术时间、术后VAS评分和未置钉节段椎体高度及每椎体相对生长率。[结果]两组病例术前患儿年龄、冠状位及矢状位Cobb角无明显差异;所有病例均顺利完成手术,无神经系统并发症,无围手术期死亡患儿。两组病例术后即刻冠状位和矢状位Cobb角均有改善;微创多节段小切口组切口长度、出血量均小于传统后路组,差异有统计学意义(P<0.05);而手术时间和VAS评分与传统后路组比较差异无统计学意义(P>0.05)。全部病例随访12~43个月,平均(23.61±9.42)个月,微创小切口组与传统后路组椎体高度均有增长,但微创小切口组增长更明显,差异有统计学意义(P<0.05)。随访期间,未出现断钉、断棒等内固定相关并发症。[结论]使用微创多节段小切口滑槽钉生长棒治疗儿童脊柱侧凸,能有效矫正畸形,相比传统后路开放手术更有效保留了脊柱的生长发育能力,具有创伤小、出血少、恢复快等优点。
[Objective] To evaluate the clinical efficacy of growing rods through multi-segment small incisions for idiopathic scoliosis in children. [Methods] From January 2014 to July 2017, 8 patients, including 3 males and 5 females with an average age of(7.75±1.47) years, were treated with growing rods through multi-segment small incisions for idiopathic scoliosis. Meanwhile, 14 children who underwent the growing rods through a traditional posterior incision for the scoliosis were set as the control, including 4 males and 10 females with age of(7.57±1.71) years old. The incision length, intraoperative bleeding, operation time, and visual analogue scale(VAS) for pain as well as radiographic measurements, including Cobb angle, correction rate in Cobb angle, the height of vertebral body, as well as the relative vertebral growth rate were compared between the two groups.[Results] There were no significant differences in age, coronal and sagittal Cobb angle between the two groups before operation(P>0.05). All children had operation performed smoothly without neurological complications and perioperative death. The small incision group had statistically shorter incision length and less blood loss than the traditional incision group(P<0.05), despite no statistical differences regarding to operation time and postoperative VAS between them(P>0.05). Both the small incision group and the traditional incision group got statistical improvement in coronal and sagittal Cobb angles immediately after operation(P<0.05). The children were followed up for 12 to 37 months with an average of(23.61±9.42) months. Statistical increases in vertebral height were noted in both groups, however, small incision group was more obviously enhanced regarding to the vertebral height than the traditional incision group with a statistically significant difference(P<0.05). During the follow-up period, no complications such as screw broken, rod fracture or loosening were noticed in anyone of the children. [Conclusion] This growing rods through multi-segment small incision with advantages of minimized damage, decreased blood loss and improved recovery over the operation through a traditional incision does achieve satisfactory outcomes for idiopathic scoliosis in children.
[Objective] To evaluate the clinical efficacy of growing rods through multi-segment small incisions for idiopathic scoliosis in children. [Methods] From January 2014 to July 2017, 8 patients, including 3 males and 5 females with an average age of(7.75±1.47) years, were treated with growing rods through multi-segment small incisions for idiopathic scoliosis. Meanwhile, 14 children who underwent the growing rods through a traditional posterior incision for the scoliosis were set as the control, including 4 males and 10 females with age of(7.57±1.71) years old. The incision length, intraoperative bleeding, operation time, and visual analogue scale(VAS) for pain as well as radiographic measurements, including Cobb angle, correction rate in Cobb angle, the height of vertebral body, as well as the relative vertebral growth rate were compared between the two groups.[Results] There were no significant differences in age, coronal and sagittal Cobb angle between the two groups before operation(P>0.05). All children had operation performed smoothly without neurological complications and perioperative death. The small incision group had statistically shorter incision length and less blood loss than the traditional incision group(P<0.05), despite no statistical differences regarding to operation time and postoperative VAS between them(P>0.05). Both the small incision group and the traditional incision group got statistical improvement in coronal and sagittal Cobb angles immediately after operation(P<0.05). The children were followed up for 12 to 37 months with an average of(23.61±9.42) months. Statistical increases in vertebral height were noted in both groups, however, small incision group was more obviously enhanced regarding to the vertebral height than the traditional incision group with a statistically significant difference(P<0.05). During the follow-up period, no complications such as screw broken, rod fracture or loosening were noticed in anyone of the children. [Conclusion] This growing rods through multi-segment small incision with advantages of minimized damage, decreased blood loss and improved recovery over the operation through a traditional incision does achieve satisfactory outcomes for idiopathic scoliosis in children.
引文
[1]Sun X,Wang B,Qiu Y,et al.Outcomes and predictors of brace treatment for girls with adolescent idiopathic scoliosis[J].Orthop Surg,2010,2(4):285-290.
[2]Dolan LA,Wright JG,Weinstein SL.Effects of bracing in adolescents with idiopathic scoliosis[J].N Engl J Med,2014,3 70(17):681.
[3]Maruyama T,Kitagawa T,Takeshita K,et al.Conservative treatment for adolescent idiopathic scoliosis:can it reduce the incidence of surgical treatment[J].Pediatr Rehabil,2003,6(3-4):215-219.
[4]覃佳强,王忠良,李明.儿童脊柱畸形的支具治疗[J].中国矫形外科杂志,2004,12(1):24-26.
[5]Koller H,Zenner J,Gajic V,et al.The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis:a clinical study and narrative review of the literature[J].Eur Spine J,2012,21(8):514-29.
[6]王亭.脊柱侧凸后路融合术后的曲轴现象[J].中华骨科杂志,2005,25(2):63-65.
[7]王文军,薛静波,晏怡果,等.滑槽钉生长棒内固定系统置入对幼猪脊柱发育的影响[J].中华实验外科杂志,2011,28(7):1074-1075.
[8]晏怡果,王文军,姚女兆,等.滑槽钉生长棒内固定系统三维有限元的生物力学研究[J].中国矫形外科杂志,2012,20(24):2280-2283.
[9]王文军,薛静波,晏怡果,等.新型滑槽钉生长棒内固定系统治疗儿童脊柱侧凸的初步报告[J].中华骨科杂志,2013,33(2):147-151.
[10]Klemme WR,Denis F,Winter RB,et al.Spinal instrumentation without fusion for progressive scoliosis in young children[J].J Pediatr Orthop,1997,17(6):734-742.
[11]Mardjetko SM,Hammerberg KW,Lubicky JP,et al.The Luque trolley revisited.Review of nine cases requiring revision[J].Spine(Phila Pa 1976),1992,17(5):582-589.
[12]Ouellet J.Surgical technique:modern Luquétrolley,a self-growing rod technique[J].Clin Orthop,2011,469(5):1356-1367.
[13]Quick ME,Grant CA,Adam CJ,et al.A biomechanical investigation of dual growing rods used for fusionless scoliosis correction[J].Clin Biomech(Bristol,Avon),2015,30(1):33-39.
[14]González BI,Fuentes CS,Avila JMM.Anterior thoracoscopic epiphysiodesis in the treatment of a crankshaft phenomenon[J].Eur Spine J,1995,4(6):343-346.
[15]Wenger DR,Mubarak SJ,Leach J.Managing complications of posterior spinal instrumentation and fusion[J].Clin Orthop,1992,284(284):24-33.
[16]Cheung KM,Cheung JP,Samartzis D,et al.Magnetically controlled growing rods for severe spinal curvature in young children:a prospective case series[J].Lancet,2012,379(9830):1967-1974.
[17]Campbell RM,Smith MD,Hell-Vocke AK.Expansion thoracoplasty:the surgical technique of opening-wedge thoracostomy.Surgical technique[J].J Bone Joint Surg Am,2004,86-A(Suppl 1):51-64.
[18]Mc Carthy RE,Sucato D,Turner JL,et al.Shilla growing rods in a caprine animal model:a pilot study[J].Clin Orthop,2010,468(468):705-710.
[19]Betz RR,Ranade A,Samdani AF,et al.Vertebral body stapling:a fusionless treatment option for a growing child with moderate idiopathic scoliosis[J].Spine(Phila Pa 1976),2010,35(2):169-176.
[20]Harrington PR.Scoliosis in the growing spine[J].Pediatr Clin North Am,1963,10(1):225-245.
[21]谭荣.后路小切口微创分期技术在脊柱侧凸矫形中的临床应用研究[J].中国人民解放军军医进修学院,2012,20(3):33-34.
[22]邱勇,朱泽章,王斌,等.后路可延长型内固定矫正儿童脊柱侧凸的疗效及并发症[J].中华骨科杂志,2006,26(3):151-155.
[23]Xu GJ,Fu X,Tian P,et al.Comparison of single and dual growing rods in the treatment of early onset scoliosis:a meta-analysis[J].J Orthop Surg Res,2016,11(1):80.
[24]Panjabi MM.The stabilizing system of the spine.Part I.Function,dysfunction,adaptation,and enhancement[J].J Spinal Disord,1992,5:383-397.
[25]Dakwar E,Cardona RF,Smith DA,et al.Early outcomes and safety of the minimally invasive,lateral retroperitoneal transpsoas approach for adult degenerative scoliosis[J].Neurosurg Focus,2010,28(3):E8.
[26]Kim YB,Lenke LG,Kim YJ,et al.The morbidity of an anterior thoracolumbar approach:adult spinal deformity patients with greater than five-year follow-up[J].Spine(Phila Pa 1976),2009,34(8):822-826.
[2]Dolan LA,Wright JG,Weinstein SL.Effects of bracing in adolescents with idiopathic scoliosis[J].N Engl J Med,2014,3 70(17):681.
[3]Maruyama T,Kitagawa T,Takeshita K,et al.Conservative treatment for adolescent idiopathic scoliosis:can it reduce the incidence of surgical treatment[J].Pediatr Rehabil,2003,6(3-4):215-219.
[4]覃佳强,王忠良,李明.儿童脊柱畸形的支具治疗[J].中国矫形外科杂志,2004,12(1):24-26.
[5]Koller H,Zenner J,Gajic V,et al.The impact of halo-gravity traction on curve rigidity and pulmonary function in the treatment of severe and rigid scoliosis and kyphoscoliosis:a clinical study and narrative review of the literature[J].Eur Spine J,2012,21(8):514-29.
[6]王亭.脊柱侧凸后路融合术后的曲轴现象[J].中华骨科杂志,2005,25(2):63-65.
[7]王文军,薛静波,晏怡果,等.滑槽钉生长棒内固定系统置入对幼猪脊柱发育的影响[J].中华实验外科杂志,2011,28(7):1074-1075.
[8]晏怡果,王文军,姚女兆,等.滑槽钉生长棒内固定系统三维有限元的生物力学研究[J].中国矫形外科杂志,2012,20(24):2280-2283.
[9]王文军,薛静波,晏怡果,等.新型滑槽钉生长棒内固定系统治疗儿童脊柱侧凸的初步报告[J].中华骨科杂志,2013,33(2):147-151.
[10]Klemme WR,Denis F,Winter RB,et al.Spinal instrumentation without fusion for progressive scoliosis in young children[J].J Pediatr Orthop,1997,17(6):734-742.
[11]Mardjetko SM,Hammerberg KW,Lubicky JP,et al.The Luque trolley revisited.Review of nine cases requiring revision[J].Spine(Phila Pa 1976),1992,17(5):582-589.
[12]Ouellet J.Surgical technique:modern Luquétrolley,a self-growing rod technique[J].Clin Orthop,2011,469(5):1356-1367.
[13]Quick ME,Grant CA,Adam CJ,et al.A biomechanical investigation of dual growing rods used for fusionless scoliosis correction[J].Clin Biomech(Bristol,Avon),2015,30(1):33-39.
[14]González BI,Fuentes CS,Avila JMM.Anterior thoracoscopic epiphysiodesis in the treatment of a crankshaft phenomenon[J].Eur Spine J,1995,4(6):343-346.
[15]Wenger DR,Mubarak SJ,Leach J.Managing complications of posterior spinal instrumentation and fusion[J].Clin Orthop,1992,284(284):24-33.
[16]Cheung KM,Cheung JP,Samartzis D,et al.Magnetically controlled growing rods for severe spinal curvature in young children:a prospective case series[J].Lancet,2012,379(9830):1967-1974.
[17]Campbell RM,Smith MD,Hell-Vocke AK.Expansion thoracoplasty:the surgical technique of opening-wedge thoracostomy.Surgical technique[J].J Bone Joint Surg Am,2004,86-A(Suppl 1):51-64.
[18]Mc Carthy RE,Sucato D,Turner JL,et al.Shilla growing rods in a caprine animal model:a pilot study[J].Clin Orthop,2010,468(468):705-710.
[19]Betz RR,Ranade A,Samdani AF,et al.Vertebral body stapling:a fusionless treatment option for a growing child with moderate idiopathic scoliosis[J].Spine(Phila Pa 1976),2010,35(2):169-176.
[20]Harrington PR.Scoliosis in the growing spine[J].Pediatr Clin North Am,1963,10(1):225-245.
[21]谭荣.后路小切口微创分期技术在脊柱侧凸矫形中的临床应用研究[J].中国人民解放军军医进修学院,2012,20(3):33-34.
[22]邱勇,朱泽章,王斌,等.后路可延长型内固定矫正儿童脊柱侧凸的疗效及并发症[J].中华骨科杂志,2006,26(3):151-155.
[23]Xu GJ,Fu X,Tian P,et al.Comparison of single and dual growing rods in the treatment of early onset scoliosis:a meta-analysis[J].J Orthop Surg Res,2016,11(1):80.
[24]Panjabi MM.The stabilizing system of the spine.Part I.Function,dysfunction,adaptation,and enhancement[J].J Spinal Disord,1992,5:383-397.
[25]Dakwar E,Cardona RF,Smith DA,et al.Early outcomes and safety of the minimally invasive,lateral retroperitoneal transpsoas approach for adult degenerative scoliosis[J].Neurosurg Focus,2010,28(3):E8.
[26]Kim YB,Lenke LG,Kim YJ,et al.The morbidity of an anterior thoracolumbar approach:adult spinal deformity patients with greater than five-year follow-up[J].Spine(Phila Pa 1976),2009,34(8):822-826.