EVALUATION OF THE RESULTS OF THE USE OF VEPTR IN PATIENTS WITH SCOLIOSIS

ABSTRACT Objective: Evaluation of the results of the use of VEPTR (Vertical Expandable Prosthetic Titanium Rib - Synthes Spine Co.(r), West Chester, Pennsylvania, USA) as an option in spinal instrumentation without fusion in younger children with scoliosis, considering the complications inherent to spinal fusion in this age group. Methods: Sixteen (16) patients with scoliosis, regardless of etiology, with a mean age of 5.2 (3-8) years, were followed up by Spine Surgery Group at Hospital Getúlio Vargas, Recite-PE, and were submitted to surgical correction of the deformity using VEPTR, from April/2009 to July/2014. The survey was conducted through medical register review, and photographic and radiographic records, with the measurement of pre- and postoperative curves by the Cobb method. Results: The mean values of Cobb angle in the preoperative period, in the immediate postoperative period and after the last distraction were, respectively, 84.1° (112°-60°), 55.4° (92°-16°) and 64.4° (100°-16°), with an average initial correction of 28.7° (34.1%) and final correction of 19.7° (23.4%). The mean follow-up was 23.1 (0-61) months with an average distraction of 3.1 (0-8). The complication rate in this study was 62.5%. Conclusion: The VEPTR presented considerable correction rates of scoliosis curves in patients whose age contraindicate the spinal fusion methods. It is necessary to improve the technique and the implant itself in order to reduce complication rates, which can be considered relatively high, in addition to the conduction of more studies with longer follow-up to determine the actual efficacy of the implant and the maintenance of long-term correction.

摘要 目的：评估垂直可扩张钛肋骨假体（VEPTR，全称Vertical Expandable Prosthetic Titanium Rib，由美国宾夕法尼亚州西切斯特的辛迪思脊柱公司（Synthes Spine Co.）生产）在低龄脊柱侧凸患儿非融合脊柱内固定术中的应用效果，同时考量该年龄段脊柱融合术固有的并发症风险。方法：2009年4月至2014年7月间，巴西伯南布哥州累西腓市格图利奥·瓦尔加斯医院脊柱外科团队对16例各类病因的脊柱侧凸患儿（平均年龄5.2岁，年龄范围3~8岁）实施了VEPTR畸形矫正手术。本研究通过回顾病历资料、影像及放射学记录开展，采用科布法（Cobb法）测量术前与术后的脊柱弯曲角度。结果：术前、术后即刻及最后一次撑开后的Cobb角平均值分别为84.1°（范围112°~60°）、55.4°（范围92°~16°）及64.4°（范围100°~16°）；初始平均矫正度数为28.7°，矫正率34.1%，最终平均矫正度数为19.7°，矫正率23.4%。患者平均随访时长23.1个月，随访范围0~61个月，平均撑开次数3.1次，范围0~8次。本研究的并发症发生率为62.5%。结论：对于年龄属于脊柱融合术禁忌证的脊柱侧凸患儿，VEPTR可获得可观的脊柱侧凸曲度矫正效果。需进一步优化手术技术与植入物本身，以降低相对较高的并发症发生率；此外还需开展更长随访周期的更多研究，以明确该植入物的实际疗效及长期矫正效果的维持情况。