Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty
Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty
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DOI：
10.2106/00004623-200303000-00002
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发表时间：
2003-03-01
影响因子：
5.3
通讯作者：
Hell-Vocke, AK
中科院分区：
文献类型：
--
作者：
Campbell, RM;Hell-Vocke, AK
背景资料：先天性胸椎侧凸合并肋骨融合伴单侧不分节横杠邻近凸半椎体的儿童，若不治疗，其弯曲进展不可避免。手术被认为对这类患者胸椎的生长抑制作用可以忽略不计，因为人们一直假设弯曲的凹侧和单侧未分段的杆不会生长，但我们不知道关于这一假设的任何结论性研究。方法：结果：1.观察了脊柱前后凹侧、凸侧、椎体前后缘、后弓、对21例先天性脊柱侧凸合并肋骨融合的儿童，采用垂直可膨胀钛制假体肋骨行胸廓成形术后，测量了单侧胸椎不分节段的横截骨。其中3名儿童以前接受过后路脊柱融合术。使用三维软件程序进行测量，分析基线和随访计算机断层扫描。该技术通过测量一个小的女性成人cadvertiser.Results的胸部进行验证：没有脊柱融合的患者有一个平均年龄为3.3年的时间的基线计算机断层扫描，平均持续时间为4.2年的后续行动。平均而言，与基线相比，这些患者的胸椎凹侧（长度增加7.9毫米/年，或7.1%/年）和凸侧（8.3毫米/年，或6.4%/年）显着增长（p < 0.0001）。长度。凹侧和凸侧之间的长度增加无显著差异（p = 0.38）。11名使用未分段杆的患者的杆长度平均增加7.3%（p < 0.0001）。在3名既往接受过脊柱融合术的儿童中，胸椎凹侧的长度平均仅增加4.6 mm/年（3%/年），（2.2%/年）的凸侧;这两个增加是显着的结论：正常儿童在5 ~ 9岁之间胸椎的纵向生长估计为0.6 cm/年。在我们的先天性脊柱侧凸和肋骨融合的儿童系列中，胸廓扩张成形术后，胸椎生长约为8 mm/年。胸廓扩张成形术后，这些患者的胸椎凹侧和凸侧以及单侧不分节条均出现生长。当胸廓已经因先天性脊柱侧凸而缩短时，通过扩张胸廓成形术来控制脊柱畸形可以使胸椎生长，并且较长的胸廓可能为潜在的肺部生长提供额外的体积，可能具有临床益处。证据等级：治疗性研究，IV级（病例系列[无，或历史对照组]）。证据等级的完整描述见作者说明。
Background: Children with congenital thoracic scoliosis associated with fused ribs with a unilateral unsegmented bar adjacent to convex hemivertebrae will invariably have curve progression without treatment. Surgery has been thought to have a negligible growth-inhibition effect on the thoracic spine in such patients because it has been assumed that the concave side of the curve and the unilateral unsegmented bar do not grow, but we are unaware of any conclusive studies regarding this assumption.Methods: The changes in the length of the concave and convex sides, anterior and posterior vertebral edges, posterior arch, and unilateral unsegmented bars of the thoracic spine were measured in the twenty-one children with congenital scoliosis and fused ribs after expansion thoracoplasty had been carried out with use of a vertical, expandable titanium prosthetic rib. Three of these children had undergone posterior spinal fusion previously. Measurements were made with use of a three-dimensional software program that analyzed baseline and follow-up computed tomography scans. The technique was validated through measurement of the thorax of a small female adult cadaver.Results: The patients without spine fusion had an average age of 3.3 years at the time of the baseline computed tomography scan, and the average duration of follow-up was 4.2 years. On the average, these patients showed significant growth (p < 0.0001) of the concave side of the thoracic spine (an increase in length of 7.9 mm/yr, or 7.1%/yr) and the convex side (8.3 mm/yr, or 6.4%/yr) compared with the baseline lengths. There was no significant difference in the increases in length (p = 0.38) between the concave and convex sides. Eleven patients with an unsegmented bar had an average 7.3% increase in the length of the bar (p < 0.0001). In the three children with prior spinal fusion, the increase in length averaged only 4.6 mm/yr (3%/yr) on the concave side of the thoracic spine and 3.7 mm/yr (2.2%/yr) on the convex side; both increases were significant (p < 0.0001).Conclusions: Longitudinal growth of the thoracic spine in a normal child has been estimated to be 0.6 cm/yr between the ages of five and nine years. After expansion thoracoplasty, growth of the thoracic spine was approximately 8 mm/yr in our series of children with congenital scoliosis and fused ribs. After expansion thoracoplasty, both the concave and the convex side of the thoracic spine and unilateral unsegmented bars appeared to grow in these patients. When a thorax is already foreshortened by congenital scoliosis, control of spine deformity with expansion thoracoplasty allows growth of the thoracic spine, and it is likely that the longer thorax provides additional volume for growth of the underlying lungs with probable clinical benefit.Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.