Corrective Surgery for Congenital Scoliosis Associated with Split Cord Malformation It May Be Safe to Leave Diastematomyelia Untreated in Patients with Intact or Stable Neurological Status
Corrective Surgery for Congenital Scoliosis Associated with Split Cord Malformation It May Be Safe to Leave Diastematomyelia Untreated in Patients with Intact or Stable Neurological Status
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与脊髓分裂畸形相关的先天性脊柱侧弯的矫正手术 对于神经系统状态完整或稳定的患者，不治疗脊髓纵裂可能是安全的
DOI：
10.2106/jbjs.15.00882
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发表时间：
2016-06-01
影响因子：
5.3
通讯作者：
Li, Zheng
中科院分区：
文献类型：
--
作者：
Shen, Jianxiong;Zhang, Jianguo;Li, Zheng
背景资料：先天性脊柱侧凸伴脊髓裂畸形（SCM）的治疗提出了如何最好地管理这样的患者，以避免神经功能缺损，同时实现一个令人满意的correction.Methods的问题：这项前瞻性临床研究是在我们的中心从2000年3月至2013年6月进行。我们共招募了214名（61名男性和153名女性）患有与SCM相关的先天性脊柱侧凸的患者，这些患者正在接受脊柱矫正手术。手术时的平均年龄为14.1岁。入选标准为先天性脊柱侧凸伴SCM; 2年内神经功能完整或稳定;牵引、侧弯或支点弯曲X线片显示无神经功能恶化。排除了神经系统状态不稳定或计划进行脊柱切除手术的患者。结果：根据Pang分类，Ⅰ型SCM组73例，Ⅱ型SCM组141例。两组在术前特征、手术时间、失血量或融合节段数量方面无显著差异。平均随访37个月（范围：24 - 108个月）。I型组的脊柱侧凸矫正率低于II型组（p < 0.05）。在I型组中，术后1周的矫正率为48.9%，末次随访时为42.2%。在II型组中，术后1周的矫正率为54.7%，末次随访时为47.9%。11例（5.1%）患者出现一过性神经系统并发症，两组之间无显著差异（p = 0.415）。在手术或随访期间，没有患者出现永久性神经功能缺损。结论：先天性脊柱侧凸与SCM相关的患者，无论类型如何，都可以安全有效地进行脊柱畸形矫正，实现脊柱平衡，而无需神经干预。对于这些神经系统状态完整或稳定的患者，在脊柱侧凸手术前预防性松解可能是不必要的。
Background: The treatment of congenital scoliosis associated with split cord malformation (SCM) raises the issue of how to best manage such patients to avoid neurological deficit while achieving a satisfactory correction.Methods: This prospective clinical study was performed at our center from March 2000 through June 2013. We enrolled a total of 214 patients (61 male and 153 female) with congenital scoliosis associated with SCM who were undergoing spinal correction surgery. The mean age at surgery was 14.1 years. The inclusion criteria were congenital scoliosis with confirmed SCM; status as neurologically intact or stable over the preceding 2 years; and no neurological deterioration as evidenced on traction, side-bending, or fulcrum-bending radiographs. Patients with unstable neurological status or for whom vertebral column resection surgery was planned were excluded. All patients underwent scoliosis surgery without prophylactic detethering.Results: On the basis of the Pang classification, 73 patients were in the type-I SCM group, and 141 were in the type-II SCM group. The groups did not differ significantly with respect to preoperative characteristics, operative time, blood loss, or number of levels fused. The mean follow-up was 37 months (range, 24 to 108 months). The rate of scoliosis correction was lower in the type-I group than in the type-II group (p < 0.05). In the type-I group, the correction rate was 48.9% at 1 week postoperatively and 42.2% at the last follow-up. In the type-II group, the correction rate was 54.7% at 1 week postoperatively and 47.9% at the last follow-up. Eleven (5.1%) of the patients experienced transient neurological complications, with no significant difference between the groups (p = 0.415). No patient experienced permanent neurological deficit during surgery or follow-up.Conclusions: Patients with congenital scoliosis associated with SCM, regardless of type, can safely and effectively undergo spinal deformity correction and achieve spinal balance without neurological intervention. For such patients with intact or stable neurological status, prophylactic detethering prior to scoliosis surgery may not be necessary.