目的 探讨纵向可撑开型人工钛肋技术(VEPTR)治疗早发性脊柱侧凸(EOS)的早期疗效.方法 本组共入选11例自2006年12月至2011年7月行VEPTR技术治疗的EOS患者.男性8例,女性3例,初次手术时年龄3.1~9.8岁,平均(7±3)岁.在初次手术时放置VEPTR器械,使用肋骨-肋骨连接和肋骨-腰椎连接.术后每6~12个月行撑开延长术1次.测量并比较术前、术后和末次随访时主弯Cobb角、顶椎偏移、胸椎高度和T1~S1高度.采用配对t检验比较患者初次术前、初次术后和末次随访影像学测量结果,以评估手术疗效.结果 初次手术后随访12~52个月,平均(32±11)个月.全部患者共接受手术41次,平均3.7次/例;共进行VEPTR撑开延长手术30次,平均2.7次/例.本组患者平均8个月行撑开延长1次.从术前到末次随访,主弯Cobb角从78°±18°减少到55°±11°(=4.931,P<0.05),顶椎偏移和胸椎后凸角在初次术后明显减小,随访时又有轻度增大.胸椎高度从(13.3±2.0) cm增加到(17.2±2.4)cm(t =8.365,P<0.001),T1~S1高度从(24.4±3.8)cm增加到(32.5±5.3)cm(t =9.080,P<0.001).末次随访时与初次置入VEPTR术前相比,胸椎高度和T1~S1高度分别增加(4.0±1.3)cm和(8.1±2.6)cm.置入VEPTR术后,平均每次撑开术后胸椎高度和T1 ~ S1高度分别可增加(0.8±0.3)cm和(1.8±0.4)cm.本组中有6例(共8例次)发生术中和(或)术后并发症,包括肋骨抱钩移位、迟发性感染、术中胸膜破裂和腰椎螺钉松动.结论 VEPTR技术可有效控制EOS患者脊柱侧凸畸形的进展,并能保持脊柱和胸廓的生长,可作为EOS治疗的有效方法.由于手术相关并发症发生率较高,临床需要严格控制适应证.
Objective To investigate the early outcome of vertical expandable prosthetic titanium rib (VEPTR) technique in treating early-onset scoliosis.Methods This study recruited 11 early-onset scoliosis patients ( 8 boys and 3 girls) who received VEPTR treatment from December 2006 to July 2011 with a minimum follow-up of 12 months.The average age at initial surgery was (7 ±3) years (range,3.1 to 9.8 years). VEPTR device,either rib to rib or rib to lumbar,was implanted at initial surgery. During the regular post-operative follow-ups,expansion surgeries were scheduled at an interval of 6 to 12 months.Measurements of primary curve magnitude,apical vertebral translation,thoracic height and T1-S1 height were performed on radiographs,and were compared between those of preoperatively,postoperatively,and at latest follow-up through paired-t tests.Results All patients had a mean follow-up of (32 ± 11 ) months.Totally 41 surgeries were performed,averagely 3.7 surgeries per patient ; and 30 expansion surgeries were carried out,averagely 2.7 surgeries per patient.The average interval for each expansion surgery was 8 months.From preoperatively to latest follow-up,the Cobb angle of primary curves was averagely corrected from 78° ±18° to 55° ±11° (t =4.931,P < 0.05 ),and apical vertebral translation and thoracic kyphosis displayed slight improvement.Average thoracic height increased from ( 13.3 ± 2.0 ) cm to ( 17.2 ± 2.4 ) cm ( t =8.365,P <0.001 ),and average T1-S1 height from ( 24.4 ± 3.8 ) cm to ( 32.5 ± 5.3 ) cm ( t =9.080,P <0.001 ).After initial surgery with VEPTR instrumented,gains in thoracic height and T1-S1 height per expansion surgery averaged (0.8 ± 0.3 ) cm and ( 1.8 ± 0.4) cm,respectively.Eight complications occurred in 6 patients,including rib cradle dislodgements,displayed infection,intraoperative pleura rupture and loosening of lumbar pedicle screws. Conclusions VEPTR technique proves to be an effective way of preventing curve progression in early-onset scoliosis patients while allowing growth of spine and chest.Yet,indications for such a technique need to be strictly selected because of the relatively high complication rate.