滑动生长棒技术治疗儿童早发性脊柱侧凸的初步研究

A preliminary study on sliding growth rod technique for early onset scoliosis in children

[目的]探究滑动生长棒技术治疗早发性脊柱侧凸(early onset scoliosis, EOS)的临床疗效。[方法]对于2013年1月～2016年9月本科收治的9例EOS患者采用滑动生长棒技术手术治疗。以T_1～S_1、T_1～T_(12)和固定节段的高度作为脊柱生长的主要评价指标,同时测量患者术前、术后和末次随访时的冠状面和矢状面参数。记录随访期间再手术次数和各类并发症情况。[结果] 9例患儿随访24～49个月,平均(28.74±7.62)月。主弯Cobb角由术前的(70.33±10.47)°显著纠正至术后1周的(26.19±6.80)°(P<0.05),末次随访时为(23.03±5.12)°。T_1～S_1高度由术前(23.74±2.27) cm,显著增至术后1周的(27.42±2.11) cm,末次随访时为(30.42±2.37) cm,不同时间点间的差异有统计学意义(P<0.05);T_1～T_(12)高度由术前(14.53±1.82) cm,显著增至术后1周(16.65±1.93) cm,末次随访时(18.92±2.11) cm,不同时间点间的差异有统计学意义(P<0.05);固定节段高度由术后1周的(19.26±2.17) cm显著增加至末次随访的(21.54±2.25) cm(P<0.05)。术后2年时,固定节段高度增加了1.32 cm,固定节段生长速度为0.66 cm/年。术后仅1例出现Adding-on现象,1例于术后2年6个月更换更长的金属棒。无手术切口感染、断钉、断棒等并发症。[结论]滑动生长棒技术在纠正EOS侧弯的同时有效保留了脊柱生长潜能,有效减少了撑开手术次数,降低了手术并发症。

[Objective] To explore the clinical outcomes of sliding growth rod technique for the early onset scoliosis(EOS)in children. [Methods] From January 2013 to September 2016, 9 children with EOS were surgically treated with sliding growth rod technique in our hospital. The height of T1~S1, T1~T12 and instrumented length were determined, while the coronal and sagittal parameters were also measured to assess the spinal growth, additionally reoperation and complication were recorded. [Results] The 9 children were followed up for 24 to 49 months with an average of(28.74±7.62) months. The Cobb angle of main curvature significantly decreased from(70.33±10.47)° preoperatively to(26.19±6.80)° at 1 week after surgery(P<0.05), further to(23.03±5.12)° at the latest follow-up. In addition, the height of T1~S1 significantly increased from(23.74±2.27) cm preoperatively to(27.42±2.11) cm at 1 week postoperatively, further to(30.42±2.37) cm at the latest follow-up with a statistically significant difference among time points(P<0.05). The height of T1~T12 significantly increased from(14.53±1.82) cm to(16.65±1.93) cm,further to(18.92±2.11) cm with a statistically significant difference among time points(P<0.05). In addition, the fixed segment height was(19.26±2.17) cm at 1 week postoperatively, which was significantly increased to(21.54±2.25) cm at the latest followup(P<0.05). At 2 years after surgery, the height of the instrumented segments increased by 1.32 cm, and the growth rate of the instrumented segment was 0.66 cm/year. Of them, only one case showed adding-on phenomenon, and one case was replaced with a longer metal rod at 2 years and 6 months after surgery. No complications, such as surgical wound infection, broken nails and broken rods, happened in any of the children. [Conclusion] The sliding growth rod technique does effectively preserve the spine growth potential while correcting the EOS curvature,and effectively reduce distraction operations and related complications.