10岁以下儿童一期后路半椎体切除术的手术时机选择研究

Selection of surgical timing for posterior-only hemivertebra resection in children younger than 10 years

背景:后路半椎体切除已经成为治疗儿童先天性脊柱侧凸的常用方法,但对于10岁以下儿童,何时行半椎体切除尚无定论。目的:探讨10岁以下儿童脊柱一期后路半椎体切除术的合适手术时机。方法:回顾性分析2010年1月至2017年12月因先天性脊柱侧凸畸形于我院行一期后路半椎体切除短节段固定的104例患儿资料,其中男51例,女53例;年龄1.6~9.9岁,平均(4.1±2.2)岁。按年龄将患儿分为3组,分别为患儿年龄<3岁(n=47),年龄为3~6岁(n=32),年龄>6岁(n=25)。手术前、后及末次随访时所有患儿均行站立位全脊柱正侧位X线检查。记录并对比3组患儿手术前后主弯Cobb角、近端及远端代偿弯Cobb角、节段性后凸角;记录并对比3组患儿的手术时间、术中出血量、固定节段及并发症发生情况。结果:随访时间为36~116个月,平均(52.9±10.2)个月。年龄<3岁组患儿平均手术年龄(2.5±0.4)岁,年龄为3~6岁组(4.3±0.8)岁,年龄>6岁组(7.8±1.4)岁,3组患儿的手术年龄比较差异有统计学意义(P<0.001)。3组患儿主弯Cobb角矫形率、近端及远端代偿弯矫形率及节段性后凸角矫形率比较,差异均无统计学意义(P>0.05)。年龄>6岁组固定节段显著多于年龄<3岁组(P<0.05),内固定相关并发症发生率年龄<3岁组显著高于其他两组(P<0.05)。手术时间和术中出血量年龄>6岁组多于其他两组(P<0.05)。结论:后路半椎体切除术治疗10岁以下儿童先天性脊柱侧凸是安全有效的手术方式。不同年龄的患儿手术矫形效果无明显差异,但3岁以下手术内固定相关并发症发生率高,6岁以上手术固定节段较长,且手术时间和术中出血量较多。因此,3~6岁是儿童行半椎体切除术的合适年龄段。

Background:Hemivertebra resection by posterior approach is popular for congenital scoliosis in children.However,there is no consensus about when to do the hemivertebra resection for children younger than 10 years old.Objective:To evaluate the optimal surgical timing for one-stage posterior thoracolumbar hemivertebra resection in children younger than 10years.Methods:Retrospective analysis was conducted for the clinical data of 104 congenital scoliosis children with thoracolumbar hemivertebra undergoing one-stage posterior-only hemivertebra resection with short-segment internal fixation and fusion,with at least a 36-month follow-up,from January 2010 to December 2017.There were 51 males and 53 females,aged 1.6-9.9years with a mean age of(4.1±2.2)years.Standing anteroposterior and lateral radiographs of full spine were acquired and compared pre-operatively,post-operatively and at the last follow-up.Radiographic evaluation included measured changes in Cobb angle,segmental kyphosis and compensatory proximal and distal scoliosis.All children were divided into three groups:before 3 years of age group(n=47),aged 3-6 years group(n=32)and after 6 years of age group(n=25).The clinical data and spinal radiographs measurements were compared among 3 groups.Results:The mean follow-up period was(52.9±10.2)months(range,36-116 months).The children’mean age was(2.5±0.4)years in before 3 years of age group,(4.3±0.8)years in aged 3-6 years group,and(7.8±1.4)years in after 6 years of age group(P<0.001).The Cobb angle of the main curve before surgery,corrective rate of main curve,corrective rate of segmental kyphosis and compensatory proximal and distal curve after surgery were not found to be statistically different among the three groups(P>0.05).Before 3 years of age group had higher instrumentation-related complication incidence than the other groups(P<0.05);after 6 years of age group had more fixed segments than before 3 years of age group(P<0.05).The time of operation and estimated blood loss of after 6 years of age group were more than the other two groups(P<0.05).Conclusions:One-stage posterior-only hemivertebra resection with short-segment internal fixation and fusion is effective and safe for children younger than 10 years.The corrective outcome is similar in children of different ages.However,children younger than 3 years can suffer more instrumentation-related complications,while children older than 6 years have more fixed levels,operation time and blood loss.Thus,children aged 3 to 6 years old are proper for hemivertebra resection with short-segment fusion.