基于神经中央软骨生长调控的早发性脊柱侧弯矫正模式的动物实验研究

Early-onset scoliosis (EOS) refers to scoliosis that presents in children aged <5 years, characterized by rapid curve progression and thoracic insufficiency, which requires early intervention. However, currently available treatment measures for EOS, including growing rod technique, remain to be ineffective to control the rotation of vertebrae, probably resulting in curve progression and pulmonary function deterioration. Therefore, it is imperative to create a scoliosis model with growth property similar to human EOS, and further to develop a novel non-fusion correction technique for EOS in this model. Neurocentral synchondrosis (NCS), a three-dimension cartilage located at the junction of the vertebral body and the pedicle, is believed to contribute to the growth of both the vertebral body and the posterior arch. As demonstrated in previous studies, disturbance of unilateral NCS could lead to remarkable vertebral rotation, suggesting that asymmetric growth of NCS might be not only one of the initiating factors of EOS development, but one of the main contributing factors to curve progression as well. Hence, in the current study, we aim to establish a porcine scoliosis model similar to human EOS by way of producing vertebral rotation via unilaterally inserting pedicle screws through NCS, and further, to treat the produced scoliosis through restoring the balance of NCS growth on both sides with pedicle screw placement in the contralateral side. It is expected that this study will provide a novel solution to EOS as far as correction of vertebral rotation is concerned.

早发性脊柱侧弯（EOS）指5岁以前发生的脊柱侧弯，通常畸形进展迅速，影响胸廓发育，因而需要早期干预。包括生长棒技术在内的现有治疗手段，均无法有效控制顶椎旋转，使得脊柱畸形难以控制。构建生长特性类似于人类患儿的EOS动物模型，并探索新型非融合矫形技术治疗EOS，是当前急需解决的问题。神经中央软骨（NCS）是位于椎体及椎弓根交界处的一对三维结构软骨板，其作用是促使幼儿（动物）双侧椎弓和椎体的生长。既往研究证实破坏单侧NCS会引起脊椎旋转，提示NCS的不对称生长既可能是EOS重要的始动因素，还可能是影响侧弯畸形加重的重要因素。因此，本项目组拟通过在动物中单侧置入椎弓根螺钉，诱导NCS不对称生长，产生顶椎旋转进而造成脊柱侧弯，以此建造EOS模型；并在形成结构性脊柱侧弯模型后，在顶椎区另一侧置入椎弓根螺钉破坏该侧NCS，进而干预双侧NCS直至其生长平衡，以达到通过控制顶椎旋转而实现治疗EOS的目的。

早发性脊柱侧弯（EOS）指5岁以前发生的脊柱侧弯，通常畸形进展迅速，影响胸廓发育，因而需要早期干预。包括生长棒技术在内的现有治疗手段，均无法有效控制顶椎旋转，使得脊柱畸形难以控制。构建生长特性类似于人类患儿的EOS动物模型，并探索新型非融合矫形技术治疗EOS，是当前急需解决的问题。既往研究证实破坏单侧NCS会引起脊椎旋转，提示NCS的不对称生长既可能是EOS重要的始动因素，还可能是影响侧弯畸形加重的重要因素。本项目通过在椎体单侧椎弓根置钉诱导NCS不对称生长成功构建脊柱侧凸模型，延长内固定节段可以更好的构建脊柱侧凸模型。在该脊柱侧凸模型上，反向干预对侧神经中央软骨发育可有效预防脊柱侧凸进一步进展。需要注意的是在幼猪生长发育过程中，干预神经管中央软骨发育会显著影响椎管的发育。在临床方面，传统生长棒虽然可以维持脊柱纵向的生长发育，但明显存在顶椎旋转控制不足的局限性。Hybrid手术技术相比于传统生长棒技术在治疗先天性早发性脊柱侧凸方面，可以维持脊柱纵向生长发育的同时更好的矫正脊柱侧后凸畸形，获得满意的临床疗效。