Assessment of the efficacy of treatment for children with congenital scoliosis with unsegmented bar and rib synostosis

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BACKGROUND: Treatment of children with congenital deformity with unsegmented rod and rib synostosis is an important and topical problem to date. Topical publications present the results of surgical correction efficacy and analysis of treatment complications. The extremely important aspect of treatment efficacy assessment regarding changes in the function of external respiration is still topical.

AIM: This study aimed to analyze the treatment results of children with congenital scoliosis and unilateral segmentation disorder of the lateral surfaces of the vertebral bodies and rib synostosis.

MATERIALS AND METHODS: This is a retrospective monocenter cohort study of the treatment outcomes of 30 patients aged 1–14 years. In the preoperative period, external respiration was evaluated by pulse oscillometry, multi-slice computed tomography, digital X-ray imaging of the craniopelvis in two projections. All patients underwent expanding thoracoplasty with osteotomy of the rib synostosis and fixation with a rib-costal or rib-vertebral distractor. Control studies were performed every 6 months after the surgical intervention. The average follow-up period was 2 years. Nonparametric analysis was applied to estimate the obtained data.

RESULTS: The median (Me) age at the start of treatment was 6 years (interquartile range, 4.25; IQR hereafter). The Me scoliosis before treatment was 74° (IQR, 22.75). The Me scoliosis correction after the first stage of treatment was 16° (IQR, 11) and the second correction achieved 6° (IQR, 13). The Me kyphosis was 15° (IQR, 32), the first intervention improved kyphosis by 4° (IQR, 16), and the second by 6° (IQR, 11).

Complications were represented by the destabilization of the metal construct in six cases, and trophic disorders of soft tissues were noted in four. The assessment of external respiratory function using IOM demonstrates reliable improvement of resistive component, reactive component, and frequency dependence of the resistive component (p < 0,01).

CONCLUSIONS: The assessment of the external respiratory function in young children and analysis of reference values may allow their use as absolute indications for surgical treatment in children with congenital scoliosis with unsegmented bar and rib synostosis.

作者简介

Sergei V. Vissarionov

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: vissarionovs@gmail.com
ORCID iD: 0000-0003-4235-5048
SPIN 代码: 7125-4930
Scopus 作者 ID: 6504128319
Researcher ID: P-8596-2015

MD, PhD, D.Sc., Professor, Corresponding Member of RAS

俄罗斯联邦, Saint Petersburg

Marat S. Asadulaev

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

编辑信件的主要联系方式.
Email: marat.asadulaev@yandex.ru
ORCID iD: 0000-0002-1768-2402
SPIN 代码: 3336-8996
Scopus 作者 ID: 57191618743

MD, PhD student

俄罗斯联邦, Saint Petersburg

Elena A. Orlova

Children’s municipal multi-specialty clinical center of high medical technology named after K.A. Rauhfus

Email: eaorlova@mail.ru
ORCID iD: 0000-0002-3128-980X

MD, PhD, Cand. Sci. (Med.), doctor of functional diagnostics

俄罗斯联邦, Saint Petersburg

Polina Ivanova

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: polinaiva2772@gmail.com

MD, resident

俄罗斯联邦, Saint Petersburg

Anton Shabunin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: anton-shab@yandex.ru
ORCID iD: 0000-0002-8883-0580
SPIN 代码: 1260-5644
Scopus 作者 ID: 57191623923

Research Associate

俄罗斯联邦, Saint Petersburg

Tatyana V. Murashko

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: popova332@mail.ru
ORCID iD: 0000-0002-0596-3741
SPIN 代码: 9295-6453

MD, radiologist

俄罗斯联邦, Saint Petersburg

Mikhail A. Khardikov

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: khardikov21@gmail.com
ORCID iD: 0000-0002-8269-0900
SPIN 代码: 3378-7685
Scopus 作者 ID: 57203014683

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Vachtang G. Toriya

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: vakdiss@yandex.ru
ORCID iD: 0000-0002-2056-9726
SPIN 代码: 1797-5031

MD, neurosurgeon

俄罗斯联邦, Saint Petersburg

Timofey S. Rybinskikh

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: timofey1999r@gmail.com
ORCID iD: 0000-0002-4180-5353
SPIN 代码: 7739-4321

6th year student

俄罗斯联邦, Saint Petersburg

Kristina Rodionova

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: rkn0306@mail.ru
ORCID iD: 0000-0001-6187-2097
SPIN 代码: 4627-3979

3rd year student

俄罗斯联邦, Saint Petersburg

Dmitriy Kokushin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: partgerm@yandex.ru
ORCID iD: 0000-0002-2510-7213
SPIN 代码: 9071-4853
Scopus 作者 ID: 57193257768

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

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2. Fig. 1. Histogram of the distribution of patients by age groups at the start of surgical treatment

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3. Fig. 2. Synostosis of the ribs (a). Appearance of the ribs after osteotomy of the synostosis of the ribs (b). Surgical intervention site after endoprosthesis replacement of the hardware and correction of the deformity (c): 1, zones of synostosis of the ribs; 2, osteotomy site; 3, area of the rib capture installation; 4, area of pedicle screw installation; 5, rib system connector; 6, length of the rod required to perform staged surgical interventions

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4. Fig. 3. Panoramic radiograph of the spine in frontal and lateral projections before and after the surgical treatment. Patient, 6 years old: a, b, scoliosis before the surgery (87°), lordosis of the thoracic spine (0°); c, d, scoliosis after the surgery (73°), kyphosis (2°)

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5. Fig. 4. CT volumetry. Patient, 6 years old: a, the lungs before the surgery; b, appearance 6 months after the surgery: a change in the spatial position of the shoulder girdle, an increase in the hemithoracic volume on the concave side, and an increase in the right lung by 72.8 cm3 (22.6%) and the left lung by 62.3 cm3 (20.7%). The total lung volume 6 months after the surgery increased by 21.7% (135.1 cm3)

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6. Fig. 5. Correlation of the volumes of the right and left lungs before and after the surgery: a, volumes before the surgery; b, volumes after the surgery. X is the volume cm3, Y is the serial number of the patient, yellow indicates the healthy side, and blue indicates the volume on the costal synostosis side. Before the surgery, the lung volume on the concave side was less than that on the convex side

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7. Fig. 6. Distribution of impulse oscillometry parameters in box-plot format before and after the surgery is indicated in gray and light gray, respectively: a, resistive component; b, reactive component; c, frequency dependence of the resistive component

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版权所有 © Vissarionov S.V., Asadulaev M.S., Orlova E.A., Ivanova P.A., Shabunin A.S., Murashko T.V., Khardikov M.A., Toriya V.G., Rybinskikh T.S., Rodionova K.N., Kokushin D.N., 2022

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