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目的:观察应用生长棒技术治疗先天性脊柱侧凸的疗效,探讨生长棒撑开手术对撑开节段内外脊柱和椎体生长发育的影响。方法:2008年6月~2013年12月采用生长棒技术治疗先天性脊柱侧凸患儿221例,术后至少有两次脊柱CT检查且2次检查间至少有1次撑开的患儿31例,男17例,女14例,首次手术时年龄3.2~9.1岁;第一次CT检查时年龄为7.1±2.3岁;末次CT检查时年龄为10.0±2.1岁。1.0~5.9年内共进92次撑开手术,人均撑开次数为3次,年均撑开次数为1.1次。第一次CT检查平均为第2次撑开,末次CT检查平均为第5次撑开。测量并比较第一次和末次CT检查时患者生长棒撑开节段内外椎体高度、主弯Cobb角、矢状位胸后凸Cobb角、T1~T12和T1~S1高度、脊柱偏移距离。结果:第一次和末次CT检查时撑开节段内单个椎体高度为18.2±4.7mm和21.8±5.5mm,撑开节段外单个椎体高度为19.2±3.2mm和22.7±3.4mm,前后两次撑开节段内外椎体高度有统计学差异(P=0.035)。撑开节段内、外单个椎体高度增加为1.4±0.9mm/yr、1.2±0.9mm/yr,差异有统计学意义(P<0.05),撑开节段内椎体比撑开节段外椎体生长快。两次测量时冠状位主弯Cobb角分别为56.8°±15.3°和52.9°±15.4°,矢状位胸后凸Cobb角为36.6°±18.9°和43.7°±18.2°,T1~12高度为16.7±3.3cm和19.1±3.3cm,T1~S1高度为27.9±4.7cm和32.5±4.7cm,差异均有统计学意义(P<0.05);脊柱平移为18.6±15.2mm和20.0±21.4mm,差异无统计学意义(P>0.05)。结论:应用生长棒技术治疗小儿先天性脊柱侧凸时撑开节段内的正常椎体生长速率快于撑开节段外的椎体生长速率,撑开期间胸椎和脊柱高度均相应增加。
OBJECTIVE: To observe the curative effect of growth bar technique on congenital scoliosis and to explore the influence of growth bar on open spine and vertebral body. METHODS: From June 2008 to December 2013, 221 children with congenital scoliosis were treated with growth bar technique. At least two spine CT examinations and at least 1 outstretch between two examinations 31 Cases, 17 males and 14 females, the age of the first surgery 3.2 to 9.1 years; the first CT examination of age 7.1 ± 2.3 years; the last CT examination of age 10.0 ± 2.1 years. During the period from 0 to 5.9 years, a total of 92 open operations were performed, with the average number of times per capita being 3 and the average number of times per open being 1.1. On average, the first CT scan was performed for the second time and the last CT scan was for the fifth time. We measured and compared the vertebral body height, primary Cobb angle, sagittal Cobb angle, T1-T12 and T1-S1 height, spine offset distance at the first and last CT examinations . Results: The height of individual vertebral body in the distraction segment was 18.2 ± 4.7mm and 21.8 ± 5.5mm at the first and final CT examinations. The individual vertebral body height outside the distraction segment was 19.2 ± 3.2mm and 22.7 ± 3.4mm, There was a significant difference in the height of the vertebral bodies between the anterior and posterior segments (P = 0.035). The height of single vertebral body in the distraction segment increased 1.4 ± 0.9mm / yr, 1.2 ± 0.9mm / yr, the difference was statistically significant (P <0.05) Outer vertebral body grows fast. The Cobb angles of the main coronal coronary curvatures were 56.8 ° ± 15.3 ° and 52.9 ° ± 15.4 ° respectively in the two measurements. The Cobb angles of the Sagittal gyroscopes were 36.6 ° ± 18.9 ° and 43.7 ° ± 18.2 °, respectively. The height of T1 ~ 12 was 16.7 ± 3.3cm and 19.1 ± 3.3cm respectively. The height of T1 ~ S1 was 27.9 ± 4.7cm and 32.5 ± 4.7cm, the difference was statistically significant (P <0.05). The mean spinal translation was 18.6 ± 15.2mm and 20.0 ± 21.4mm, The difference was not statistically significant (P> 0.05). CONCLUSION: The growth rate of normal vertebral body in the distraction segment is higher than that of the distraction segment in the treatment of pediatric congenital scoliosis. The height of the thoracic vertebral column and spine are increased accordingly.