Antti J Saarinen, Paul Sponseller, George H Thompson, Klane K White, John Emans, Patrick J Cahill, Steven Hwang, Ilkka Helenius
{"title":"骨骼发育不良的早发性脊柱侧凸患者在完成有利于生长的手术治疗后的疗效。","authors":"Antti J Saarinen, Paul Sponseller, George H Thompson, Klane K White, John Emans, Patrick J Cahill, Steven Hwang, Ilkka Helenius","doi":"10.1302/0301-620X.106B6.BJJ-2023-1417.R2","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>The aim of this study was to compare outcomes after growth-friendly treatment for early-onset scoliosis (EOS) between patients with skeletal dysplasias versus those with other syndromes.</p><p><strong>Methods: </strong>We retrospectively identified 20 patients with skeletal dysplasias and 292 with other syndromes (control group) who had completed surgical growth-friendly EOS treatment between 1 January 2000 and 31 December 2018. We compared radiological parameters, complications, and health-related quality of life (HRQoL) at mean follow-up of 8.6 years (SD 3.3) in the dysplasia group and 6.6 years (SD 2.6) in the control group.</p><p><strong>Results: </strong>Mean major curve correction per patient did not differ significantly between the dysplasia group (43%) and the control group (28%; p = 0.087). Mean annual spinal height increase was less in the dysplasia group (9.3 mm (SD 5.1) than in the control group (16 mm (SD 9.2); p < 0.001). Mean annual spinal growth adjusted to patient preoperative standing height during the distraction period was 11% in the dysplasia group and 14% in the control group (p = 0.070). The complication rate was 1.6 times higher (95% confidence interval (CI) 1.3 to 2.0) in the dysplasia group. The following complications were more frequent in the dysplasia group: neurological injury (rate ratio (RR) 5.1 (95% CI 2.3 to 11)), deep surgical site infection (RR 2.2 (95% CI 1.2 to 4.1)), implant-related complications (RR 2.0 (95% CI 1.5 to 2.7)), and unplanned revision (RR 1.8 (95% CI 1.3 to 2.5)). Final fusion did not provide additional spinal height compared with watchful waiting (p = 0.054). There were no significant differences in HRQoL scores between the groups.</p><p><strong>Conclusion: </strong>After growth-friendly EOS treatment, patients with skeletal dysplasias experienced a higher incidence of complications compared to those with other syndromes. Surgical growth-friendly treatment for skeletal dysplasia-associated EOS should be reserved for patients with severe, progressive deformities that are refractory to nonoperative treatment.</p>","PeriodicalId":48944,"journal":{"name":"Bone & Joint Journal","volume":null,"pages":null},"PeriodicalIF":4.9000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcomes after completing growth-friendly surgical treatment for early-onset scoliosis in patients with skeletal dysplasia.\",\"authors\":\"Antti J Saarinen, Paul Sponseller, George H Thompson, Klane K White, John Emans, Patrick J Cahill, Steven Hwang, Ilkka Helenius\",\"doi\":\"10.1302/0301-620X.106B6.BJJ-2023-1417.R2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>The aim of this study was to compare outcomes after growth-friendly treatment for early-onset scoliosis (EOS) between patients with skeletal dysplasias versus those with other syndromes.</p><p><strong>Methods: </strong>We retrospectively identified 20 patients with skeletal dysplasias and 292 with other syndromes (control group) who had completed surgical growth-friendly EOS treatment between 1 January 2000 and 31 December 2018. We compared radiological parameters, complications, and health-related quality of life (HRQoL) at mean follow-up of 8.6 years (SD 3.3) in the dysplasia group and 6.6 years (SD 2.6) in the control group.</p><p><strong>Results: </strong>Mean major curve correction per patient did not differ significantly between the dysplasia group (43%) and the control group (28%; p = 0.087). Mean annual spinal height increase was less in the dysplasia group (9.3 mm (SD 5.1) than in the control group (16 mm (SD 9.2); p < 0.001). Mean annual spinal growth adjusted to patient preoperative standing height during the distraction period was 11% in the dysplasia group and 14% in the control group (p = 0.070). The complication rate was 1.6 times higher (95% confidence interval (CI) 1.3 to 2.0) in the dysplasia group. The following complications were more frequent in the dysplasia group: neurological injury (rate ratio (RR) 5.1 (95% CI 2.3 to 11)), deep surgical site infection (RR 2.2 (95% CI 1.2 to 4.1)), implant-related complications (RR 2.0 (95% CI 1.5 to 2.7)), and unplanned revision (RR 1.8 (95% CI 1.3 to 2.5)). Final fusion did not provide additional spinal height compared with watchful waiting (p = 0.054). There were no significant differences in HRQoL scores between the groups.</p><p><strong>Conclusion: </strong>After growth-friendly EOS treatment, patients with skeletal dysplasias experienced a higher incidence of complications compared to those with other syndromes. Surgical growth-friendly treatment for skeletal dysplasia-associated EOS should be reserved for patients with severe, progressive deformities that are refractory to nonoperative treatment.</p>\",\"PeriodicalId\":48944,\"journal\":{\"name\":\"Bone & Joint Journal\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":4.9000,\"publicationDate\":\"2024-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Bone & Joint Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1302/0301-620X.106B6.BJJ-2023-1417.R2\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Bone & Joint Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1302/0301-620X.106B6.BJJ-2023-1417.R2","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
引用次数: 0
摘要
目的：本研究旨在比较骨骼发育不良患者与其他综合征患者在接受有利于生长的早发性脊柱侧凸（EOS）治疗后的疗效：我们回顾性地确定了2000年1月1日至2018年12月31日期间完成手术生长友好型EOS治疗的20名骨骼发育不良患者和292名其他综合征患者（对照组）。我们比较了发育不良组平均随访 8.6 年（标清 3.3）和对照组平均随访 6.6 年（标清 2.6）的放射学参数、并发症和健康相关生活质量（HRQoL）：结果：发育不良组（43%）和对照组（28%；P = 0.087）每位患者的平均主要曲线矫正率差异不大。发育不良组（9.3 mm (SD 5.1)）与对照组（16 mm (SD 9.2)；P < 0.001）相比，平均每年脊柱高度增加较少。在牵引期间，根据患者术前站立高度调整的脊柱年平均生长率在发育不良组为 11%，在对照组为 14% (p = 0.070)。发育不良组的并发症发生率是对照组的 1.6 倍（95% 置信区间 (CI) 1.3 至 2.0）。以下并发症在发育不良组更为常见：神经损伤（比率比 (RR) 5.1 (95% CI 2.3 to 11)）、手术部位深部感染（RR 2.2 (95% CI 1.2 to 4.1)）、植入物相关并发症（RR 2.0 (95% CI 1.5 to 2.7)）和计划外翻修（RR 1.8 (95% CI 1.3 to 2.5)）。与观察等待相比，最终融合术并未增加脊柱高度（P = 0.054）。两组患者的 HRQoL 评分无明显差异：结论：骨骼发育不良患者在接受生长友好型EOS治疗后，并发症发生率高于其他综合征患者。骨骼发育不良相关 EOS 的手术生长友好型治疗应仅限于非手术治疗无效的严重进行性畸形患者。
Outcomes after completing growth-friendly surgical treatment for early-onset scoliosis in patients with skeletal dysplasia.
Aims: The aim of this study was to compare outcomes after growth-friendly treatment for early-onset scoliosis (EOS) between patients with skeletal dysplasias versus those with other syndromes.
Methods: We retrospectively identified 20 patients with skeletal dysplasias and 292 with other syndromes (control group) who had completed surgical growth-friendly EOS treatment between 1 January 2000 and 31 December 2018. We compared radiological parameters, complications, and health-related quality of life (HRQoL) at mean follow-up of 8.6 years (SD 3.3) in the dysplasia group and 6.6 years (SD 2.6) in the control group.
Results: Mean major curve correction per patient did not differ significantly between the dysplasia group (43%) and the control group (28%; p = 0.087). Mean annual spinal height increase was less in the dysplasia group (9.3 mm (SD 5.1) than in the control group (16 mm (SD 9.2); p < 0.001). Mean annual spinal growth adjusted to patient preoperative standing height during the distraction period was 11% in the dysplasia group and 14% in the control group (p = 0.070). The complication rate was 1.6 times higher (95% confidence interval (CI) 1.3 to 2.0) in the dysplasia group. The following complications were more frequent in the dysplasia group: neurological injury (rate ratio (RR) 5.1 (95% CI 2.3 to 11)), deep surgical site infection (RR 2.2 (95% CI 1.2 to 4.1)), implant-related complications (RR 2.0 (95% CI 1.5 to 2.7)), and unplanned revision (RR 1.8 (95% CI 1.3 to 2.5)). Final fusion did not provide additional spinal height compared with watchful waiting (p = 0.054). There were no significant differences in HRQoL scores between the groups.
Conclusion: After growth-friendly EOS treatment, patients with skeletal dysplasias experienced a higher incidence of complications compared to those with other syndromes. Surgical growth-friendly treatment for skeletal dysplasia-associated EOS should be reserved for patients with severe, progressive deformities that are refractory to nonoperative treatment.
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