后路半脊椎切除短节段内固定治疗小儿半脊椎脊柱畸形

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[目的]探讨一期后路半脊椎切除、短节段内固定治疗半脊椎所致小儿先天性脊柱侧后凸畸形的临床疗效.[方法]回顾性分析2004年1月~2010年1月本院35例采用一期后路半脊椎切除、短节段内固定术治疗的半脊椎所致先天性脊柱侧后凸患儿,手术年龄4岁1个月~8岁5个月,平均6岁3个月.通过术前、术后及随访时站立位脊柱正位和侧位X线片测量,评价冠状面及矢状面的矫形效果.[结果]术后均随访5年以上,平均7年10个月.节段侧凸角术前平均33.20°,术后2周平均6.70°,矫正率79.82%,总侧凸角术前平均37.5°,术后2周9.9°,矫正率为73.60%;后凸角术前平均21.3°,术后2周7.9°,矫正率为62.91%.术中和术后发生螺钉切割椎弓根3例,术后切口局部感染1例.无神经系统并发症发生.末次随访侧凸及后凸矫形角度均无明显丢失.[结论]采用一期后路半脊椎切除、短节段内固定术治疗半脊椎所致的小儿先天性脊柱侧后凸融合节段少,不影响其他正常脊柱节段的生长发育,矫形效果良好,固定牢靠,并发症少,临床疗效满意,是一种安全和可行的方法.“,”[Objective] To evaluate the clinical outcome of single-stage excision of hemivertebrae combined with short segment fixation via the posterior approach for congenital kyphoscoliosis caused by hemivertebrae in children.[Methods] A total of 35 patients with congenital kyphoscoliosis caused by hemivertebrae,aged from 49 to 101 months with an average of 75 months,were admitted to our hospital from January 2004 to January 2010.All the patients received single-stage posterior hemivertebrae resection and short segment internal fixation.According to the preoperative,postoperative standing anterior-posterior,lateral plain film,the correction at the coronal and sagittal planes were analyzed respectively.[Results] Pedicle fracture happened in 2 cases intraoperatively and in 1 case postoperatively,and local incision infection was found in one.No neurological deficits occurred in any patient.The follow-up ranged from 5 years to 10 years 2 months,with the average of 7 years 10 months.The segmental curve decreased from a mean of 33.2° before surgery to 6.7° after surgery,with a mean improvement rate of 79.8%.The mean Cobb angle of the main curve decreased from 37.5° before surgery to 9.9° after surgery,with a correction rate of 73.6%.Meanwhile,the correction ratio for kyphosis was 62.9%,improving from 21.3° to 7.9° on average.At the last follow up,no significant loss of scoliotic and kyphotic correction was noted.[Conclusion] Single-stage resection of hemivertebrae combined with short segment internal fixation via the posterior approach is an effective and feasible method for treatment of con genital kyphoscoliosis in the young children caused by hemivertebrae.It provides excellent correction in both coronal and sagittal planes with shorter segment of fusion,allows for normal further growth of the unaffected parts of the spine.
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