背景:MCGR延长已成为治疗EOS患者的一项重要创新。传统种植仪器的替代品,一个单一的外科手术程序是必要的插入结构,其次是非侵入性延长在门诊设置。每一项新技术都会产生新的复杂故障。MCGR未能延长是翻修手术的重要原因。目前,关于如何定义MCGR延长故障,目前尚无共识,未能延长后需要什么步骤,以及什么因素决定了这些后续步骤。这项研究的主要目标是就如何定义和导航未能延长的MCGR达成共识。
方法:在2021年12月至2022年4月期间,对49名早发性脊柱侧凸外科医生进行了一系列3项调查,其中37项回应。共识被定义为至少70%的协议。
结果:49名外科医生中有37名(75%)对第一次调查做出了回应,所有37名外科医生都对以下两项调查(100%)做出了回应。关于调查1的25%的问题(3/12),调查2的40%的问题(4/10)和调查3的100%的问题(5/5)达成共识。达成共识的问题详见表1。在办公室中导航无法延长1毫米(97%)的杆的共识步骤包括在同一次访问中重试(78%),改变办公室的技术(88%),并且不调整延长预约的间隔时间(78%)。表1每次调查达成共识的项目(共12项)调查问题答复,共识百分比1如果杆没有拉长,你会在办公室访问中再次尝试吗?78%1确定故障延长时,XR的所有模式都是等效的?是,70%1如果延长不成功,你应该改变延长的间隔时间吗?不,78%2在未能加长杆之后重新加长杆应该改变他们的技术吗?是的,88%复位患者,100%备用棒,90%无牵引力或在连续3次杆未能加长的情况下,MCGR是否不可操作?是的,使用非操作杆确定后续步骤时的考虑因素?骨骼年龄,100%曲线进展,97%曲线刚度,93.8%的家庭便利,83%的时间年龄,从上次延长到77%的时间,70%2APP可以按照您的协议来延长未能延长的杆吗?是的,81%3您是否可以使用笨拙或失速来描述加长时执行器内部离合器失效的现象?是的,97.3%3杂音/失速在调整前重试?是,81%3定义未能加长?达到长度小于1mm,在两次未能延长事件后,你会讨论下一步的手术步骤吗?97%3一旦杆被归类为非操作性(尽管进行了干预,但不再加长),您在做出下一步决定时是否考虑潜在的诊断?是的,97%结论:使用德尔菲法的最佳临床实践指南在定义MCGR(小于1毫米)无法延长方面达成共识,对未能延长(重新尝试延长和重新定位患者)的适当反应和非功能性MCGR(未能连续延长3次)的定义。这一共识将有助于规范对这一重要问题的研究。
方法:V-专家意见。
BACKGROUND: MCGR lengthening has become an important innovation in treating patients with EOS. An alternative to traditional growing instrumentation, a single surgical procedure is necessary for insertion of the construct, followed by non-invasive lengthening in the outpatient setting. With every new technology emanates a new complication to troubleshoot. Failure to lengthen in the MCGR is a significant cause of revision surgery. Currently, no consensus exists on how to define a MCGR lengthening failure, what steps are necessary after a failure to lengthen, and what factors determine these next steps. The primary goal of this study was to establish a consensus on how to define and navigate a MCGR that fails to lengthen.
METHODS: A series of 3 surveys were distributed to 49 early onset scoliosis surgeons with 37 responses between December 2021 and April 2022.
Consensus was defined as at least 70% agreement.
RESULTS: 37 of 49 surgeons (75%) responded to the first survey, and all 37 surgeons responded to the following two surveys (100%). Consensus statements were reached on 25% of questions (3/12) from survey 1, 40% of questions (4/10) on survey 2, and 100% of questions (5/5) on survey 3. The questions that reached
consensus are detailed in Table 1. Consensus steps to navigate a rod that fails to lengthen 1 mm (97%) in the office include retrying during the same visit (78%), changing technique in the office (88%), and not adjusting the interval between lengthening appointments (78%). Table 1 Items that reached
consensus from each survey (12 total) Survey Question Response,
Consensus Percentage 1 If a rod does not lengthen, do you try again in that office visit? Yes, 78% 1 All modes of XR are equivalent when determining failure to lengthen? Yes, 70% 1 If you are unsuccessful at lengthening, you should change the lengthening interval? No, 78% 2 Re-lengthening a rod following a failure to lengthen one should change their technique? Yes, 88% Reposition patient, 100% Alternate rods, 90% No
traction in OR, 92.6% 2 Is a MCGR non-operational following 3 consecutive visits where the rod failed lengthening? Yes, 100% 2 Considerations when determining next steps with a non-operational rod? Skeletal Age, 100% Curve Progression, 97% Curve Stiffness, 93.8% Family Convenience, 83% Chronologic Age, 77% Time from Last Lengthening, 70% 2 Can an APP follow your protocol for a rod that has failed to lengthen? Yes, 81% 3 Are you comfortable using either clunk or stall to describe the phenomena of the internal clutch failing within the actuator when lengthening? Yes, 97.3% 3 Clunk/stall try again before an adjustment? Yes, 81% 3 Define failure to lengthen? Less than 1 mm length achieved, 97% 3 After two failure to lengthen events do you discuss next surgical steps? Yes, 97% 3 Once a rod had been classified as non-operational (no longer lengthening despite interventions) do you consider the underlying diagnosis when making next step decisions? Yes, 97% CONCLUSION: Best clinical practice
guidelines using a Delphi method established a
consensus on defining failure to lengthen in a MCGR (less than 1 mm), appropriate responses to failure to lengthen (re-attempt to lengthen and re-position patient) and a definition for a non-functional MCGR (failure to lengthen 3 consecutive times). This consensus will help standardize research on this important problem.
METHODS: V-expert opinion.