Эффективность применения растущих систем в лечении сколиозов c ранним началом: систематизированный обзор

Цель исследования. Систематизированный анализ литературы с оценкой эффективности применения растущих систем в лечении сколиоза c ранним началом.

Материал и методы. Проведен тематический поиск в базе Google scholar по терминам «growing rods», «early onset scoliosis», «treatment», «surgery», «growth-friendly» с использованием логических операторов AND или OR с глубиной поиска 10 лет. На первом этапе было отобрано 824 тезиса публикаций. Второй этап осуществлен в соответствии с критериями PICOS, отобрано 38 оригинальных исследований, серий наблюдений и обзоров хирургических методик коррекции деформации позвоночника с сохранением потенциала роста. Критерии оценки были разделены на 4 группы: общие данные, коррекция фронтального и сагиттального компонентов деформации, осложнения и незапланированные сценарии.

Результаты. В анализируемых работах наблюдалось гендерное равенство распределения, а средний возраст на момент первичной операции составил 6,6 года для пациентов с традиционными растущими стержнями (traditional growing rods, TGR) и Schilla/Luque Trolley и 4,9 года – для пациентов с Vertical Expandable Prosthetic Titanium Rib (VEPTR). С позиции величины коррекции деформации позвоночника минимальный результат продемонстрировали системы VEPTR (18 % коррекции), а результаты применения TGR и Schilla оказались сопоставимы (42,1 и 53,1 % соответственно), как и показатели динамики длины туловища.

Заключение. Использование систем VEPTR было сопряжено с высоким риском осложнений и несколько меньшей эффективностью коррекции деформации позвоночника, однако VEPTR незаменим при лечении синдрома торакальной недостаточности, а также тяжелых деформаций осевого скелета у детей раннего возраста с использованием внепозвоночных точек фиксации. Системы модуляции роста (Schilla и Luque Trolley) показали схожие с растущими стержнями результаты коррекции деформации.

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