双生长棒固定治疗重度早发型脊柱侧凸的疗效分析

Dual growing rod in the treatment of severe early onset scoliosis:a clinical study

目的:分析应用双生长棒固定治疗重度早发型脊柱侧凸患者的临床效果,评估其临床应用的临床疗效及安全性。方法:2007年1月~2015年6月我科收治的重度早发型脊柱侧凸并行双生长棒矫形术治疗的患者25例(男12例,女13例),初次术前主弯Cobb角均大于80°且Risser征≤Ⅰ级。测量初次手术前、手术后以及末次随访时冠状面主弯Cobb角、T1~S1高度、矢状面最大后凸角,分析患者的矫形效果及脊柱高度变化。同时收集患者初次术前、初次术后6月及末次随访的肺功能指标及胸部CT,测量患者初次术前、初次术后及末次随访时的肺容积,分析患者肺功能变化情况。结果:入组患者初次术前年龄7.8±1.4岁(5~9岁),随访时间40.3±13.1个月(22~54个月),撑开手术次数平均3.2次(3~7次)。冠状面主弯Cobb角初次术前为96.7°±15.5°,初次术后改善为50.7°±16.1°,至末次随访时改善为40.3°±10.9°;T1~S1高度由初次术前23.2±3.5cm增至初次术后31.1±3.8cm,而末次随访时增至36.5±4.2cm,矢状面最大后凸角初次术前为73.2°±18.9°,初次术后改善为47.7°±15.8°,末次随访时改善为41.2°±11.6°。患者末次随访时肺功能指标及胸廓容积较初次术前明显改善。入组患者共9例出现并发症,其中内固定相关并发症7例(8次),近端交界性后凸4例。结论:双生长棒应用于重度早发型脊柱侧凸患者的治疗可以获得良好的矫形效果,有助于改善和维持患者肺功能,但仍存在一定的手术并发症风险。

Objectives： To analyze the clinical effect of dual growing rod in the treatment of severe early onset scoliosis patients（Cobb〉80°）, and to evaluate the feasibility and safety of application. Methods： From January 2007 to June 2015, 25 patients（12 males and 13 females, Risser≤Ⅰ） who were diagnosed with severe early onset scoliosis and undergone the operation by using dual growing rod in our department were selected in our study. The Cobb angle of major curve, T1-S1 height, the maximum kyphosis angle in sagittal plane were measured. After all, the changes of these parameters were analyzed. Meanwhile, pulmonary function tests of all patients were collected before the initial operation, 6 months after the initial operation and at final follow-up. And the lung volumes of patients were measured before the initial operation, after the initial operation and at final follow-up. Then the change of pulmonary function were analyzed. Complications occurred during the period of treatment were analyzed. Results： The age of patients was 7.8±1.4 years old（range, 5-9 years old）, while the follow-up period was from 22 months to 54 months, and the mean was 40.3±13.1 months. All the patients had undergone surgery for 3 to 7 times（mean, 3.2 times）. The Cobb angle improved from 96.7°±15.5° to 50.7°±16.1° after initial surgery and to 40.3°±10.9° at final follow-up. Similarly, the T1-S1 height improved from 23.2±3.5cm to 31.1±3.8cm after initial surgery and to 36.5±4.2cm at final follow-up. While the maximum kyphosis angle in sagittal plane decreased from 73.2°±18.9° to 47.7°±15.8° and to 41.2°±11.6° at final follow-up. At final follow-up, the pulmonary function and lung volume improved significantly. While, complications related with fixation occurred in 7 patients（8 times）. Conclusions： The dual growing rod is effective in treatment for severe early onset scoliosis and appropriate for improving and maintaining the pulmonary function as well. The rate of incidence of complication is acceptable.