Anterior vertebral body tethering for immature adolescent idiopathic scoliosis: one-year results on the first 32 patients
Anterior vertebral body tethering for immature adolescent idiopathic scoliosis: one-year results on the first 32 patients
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DOI：
10.1007/s00586-014-3706-z
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发表时间：
2015-07-01
影响因子：
2.8
通讯作者：
Betz, Randal R.
中科院分区：
文献类型：
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作者：
Samdani, Amer F.;Ames, Robert J.;Betz, Randal R.
本回顾性图表回顾评估了前椎体系扎术（VBT） 1年随访的临床和影像学结果。前路VBT为骨骼发育不成熟的青少年特发性脊柱侧凸患者提供了一种无融合治疗选择。这是一种生长调节技术，利用患者的生长来实现渐进式脊柱侧凸矫正。许多动物模型支持它的承诺；然而，临床数据仍然稀少。回顾性分析临床及影像学资料。我们回顾了32例接受了至少一年随访的胸部VBT患者。收集了相关的临床和影像学资料。采用方差分析、学生t检验和Fisher精确检验对不同时间点进行比较。32例胸部特发性脊柱侧凸患者（72%为女性）进行了至少一年的随访；平均手术年龄为12岁。所有患者术前均被认为骨骼发育不成熟；平均Risser得分为0.42，平均Sanders得分为3.2。患者接受了平均7.7级的栓系（范围7-11）。中位失血量为100cc，术前平均胸曲度为42.8A度A +/- A 8.0A度，首次勃起时校正为21.0A度A +/- A 8.5A度，最近一次勃起时校正为17.9A度A +/- A 11.4A度。术前腰椎曲线25.2A°A A +/- A 7.3A°渐进式矫正（首次勃起= 18.0°A A +/- A 7.1A度，1年= 12.6°A A +/- A 9.4A度，p < 0.00001）。术前胸椎轴向旋转为13.a度，最近一次测量为7.4A度（p < 0.00001）。一名患者经历了长时间的肺不张，需要支气管镜检查；除此之外，未见重大并发症。我们的早期结果表明，对于骨骼发育不成熟的特发性脊柱侧凸患者，前路VBT是一种安全且潜在有效的治疗选择。这些患者的脊柱侧凸得到改善，主要并发症最少。然而，该队列的长期随访将揭示这种有前途的技术的真正好处。
This retrospective chart review evaluates the clinical and radiographic outcomes of anterior vertebral body tethering (VBT) at 1-year follow-up. Anterior VBT offers a fusionless treatment option for skeletally immature patients with adolescent idiopathic scoliosis. It is a growth-modulation technique, which utilizes patients' growth to attain progressive scoliosis correction. Numerous animal models support its promise; however, clinical data remain sparse.Clinical and radiographic data were retrospectively analyzed. We reviewed 32 patients who underwent thoracic VBT with a minimum one-year follow-up. Pertinent clinical and radiographic data were collected. ANOVA, Student's t test and Fisher's exact test were utilized to compare different time points.32 patients with thoracic idiopathic scoliosis (72 % female) with a minimum one-year follow-up were identified; mean age at surgery was 12 years. All patients were considered skeletally immature pre-operatively; mean Risser score 0.42, mean Sanders score 3.2. Patients underwent tethering of an average of 7.7 levels (range 7-11). Median blood loss was 100 cc. The mean pre-operative thoracic curve magnitude was 42.8A degrees A A +/- A 8.0A degrees which corrected to 21.0A degrees A A +/- A 8.5A degrees on first erect and 17.9A degrees A A +/- A 11.4A degrees at most recent. The pre-operative lumbar curve of 25.2A degrees A A +/- A 7.3A degrees demonstrated progressive correction (first erect = 18.0A degrees A A +/- A 7.1A degrees, 1 year = 12.6A degrees A A +/- A 9.4A degrees, p < 0.00001). Thoracic axial rotation measured 13.4A degrees pre-operatively and 7.4A degrees at the most recent measurement (p < 0.00001). One patient experienced prolonged atelectasis which required a bronchoscopy; otherwise, no major complications were observed.Our early results indicate that anterior VBT is a safe and potentially effective treatment option for skeletally immature patients with idiopathic scoliosis. These patients experienced an improvement of their scoliosis with minimal major complications. However, longer term follow-up of this cohort will reveal the true benefits of this promising technique.IV.