Mechanical modulation of vertebral growth in the fusionless treatment of progressive scoliosis in an experimental model
Mechanical modulation of vertebral growth in the fusionless treatment of progressive scoliosis in an experimental model
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DOI：
10.1097/01.brs.0000218662.78165.b1
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发表时间：
2006-05-20
期刊：
影响因子：
3
通讯作者：
Bachus, Kent N.
中科院分区：
文献类型：
--
作者：
Braun, John T.;Hoffman, Michael;Bachus, Kent N.
研究设计。在建立和矫正山羊实验性脊柱侧弯模型的过程中，测量了顶端脊柱节段的楔形。通过纯机械方法建立和矫正进行性实验性脊柱侧弯模型中的椎体尖端楔形畸形。在使用外固定器的大鼠尾巴模型中，已经描述了椎体楔形畸形的产生和矫正。14只山羊采用后路不对称的肋骨切除和凹肋捆扎建立实验性脊柱侧弯模型。在长达13周的时间内，所有的系绳被移除，山羊被随机分为治疗组(n=8)和未治疗组(n=6)。用四种形状记忆合金吻合器沿最大曲率的凸度行胸前路吻合术。在治疗期间，山羊又被跟踪了7到13周。使用系列X线片记录最大脊柱侧弯畸形的进展或矫正，以及测量顶端脊柱节段(两个相邻椎体和间盘)的楔形。在拴系期间，所有山羊都获得了显著的渐进性、结构性、腰椎侧弯(平均：61度，范围：49度至73度)。在拴系期开始和结束时测量的脊椎尖节段楔入分别为11.1度和22.4度。椎体顶段楔入+11.3度(椎体10.7度/椎间盘0.6度)的增加有统计学意义(P=0.001)。在治疗期间，缝合山羊的脊柱侧凸开始时为56.8度，结束时为43.4度，平均矫正-13.4度(范围为0~-22度)(P=0.001)，而未处理的山羊开始时为67.0度，结束时为59.8度，平均矫正-7.2度(范围为+7~-21度)(P=0.19)。此外，在缝合的山羊中，顶端脊柱节段在开始时测量为22.5度，在结束时测量为20.3度，平均矫正-2.2度(-0.6度椎体/-1.6度椎间盘)；在未治疗的山羊中，顶端脊椎节段在开始时测量为22.3度，在治疗期结束时测量为25.8度，平均进展+3.5度(3.5度椎体/-0.0度椎间盘)。与对照组(+3.5度)相比，吻合器组(-2.2度)和对照组(+3.5度)在顶端脊柱节段矫正和进展方面的差异有显著意义(P<；0.05)。这项研究展示了在大型动物模型中，在实验性脊柱侧弯的顶端制造楔形畸形的能力，并使用胸前吻合器控制这些畸形的进展。
Study Design. Wedging of apical spinal segments was measured during creation and correction of an experimental scoliosis in a goat model.Objectives. To create and correct apical vertebral wedge deformities in a progressive experimental scoliosis model by purely mechanical means.Summary of Background Data. The creation and correction of vertebral wedge deformities has been previously described in a rat tail model using external fixation.Methods. Experimental scoliosis was created in 14 goats using a posterior asymmetric tether with convex rib resection and concave rib tethering. After a period of up to 13 weeks, all tethers were removed and goats were randomized into treated (n = 8) and untreated (n = 6) groups. Treated goats underwent anterior thoracic stapling with four shape memory alloy staples along the convexity of the maximal curvature. Goats were followed for an additional 7 to 13 weeks during treatment. Serial radiographs were used to document progression or correction of the maximal scoliotic deformity as well as to measure the wedging of the apical spinal segment (two adjacent vertebrae and the intervening disc).Results. During the tethering period, all goats achieved a progressive, structural, lordoscoliotic curve of significant magnitude (mean: 61 degrees, range: 49 to 73 degrees). Wedging of the apical spinal segment measured 11.1 degrees at the beginning and 22.4 degrees at the end of the tethering period. The increase in apical spinal segment wedging of +11.3 degrees (10.7 degrees vertebral/0.6-degree disc) was significant (P = 0.001). During the treatment period, the scoliosis in the stapled goats measured 56.8 degrees at the beginning and 43.4 degrees at the end for an average correction of -13.4 degrees (range: 0 to -22 degrees) (P = 0.001), whereas the untreated goats measured 67.0 degrees at the beginning and 59.8 degrees at the end for an average correction of -7.2 degrees ( range: +7 to -21 degrees) (P = 0.19). Additionally, wedging of the apical spinal segment in the stapled goats measured 22.5 degrees at the beginning and 20.3 degrees at the end for an average correction of -2.2 degrees (-0.6 degrees vertebral/-1.6-degree disc); wedging of the apical vertebral segment in the untreated goats measured 22.3 degrees at the beginning and 25.8 degrees at the end of the treatment period for an average progression of +3.5 degrees (3.5 degrees vertebral/0.0-degree disc). The difference in apical spinal segment correction versus progression in the stapled (-2.2 degrees) versus control (+3.5 degrees) goats was significant (P < 0.05).Conclusions. This study demonstrates the ability to create wedge deformities at the apex of an experimental scoliosis in a large animal model and to control the progression of these deformities using anterior thoracic staples.