儿童腰椎对称型半椎体畸形的影像学特点及手术疗效分析

Imaging characteristics and surgical effect for symmetrical lumbar hemivertebrae

目的分析儿童腰椎对称型半椎体畸形的影像学特点,总结手术方案及治疗效果。方法回顾性分析2015年1月至2021年9月于北京儿童医院就诊的13例腰椎对称型半椎体患儿的临床资料,男8例,女5例,年龄[M(Q_(1),Q_(3))]为6.2(2.9,9.3)岁,术前通过全脊柱X线测量患儿节段性侧凸角、近端及远端代偿弯、胸椎后凸角、胸腰段后凸角、骶骨倾斜角、腰椎前凸等参数,通过CT及MRI判断患儿合并畸形及半椎体和后方附件的对应关系,总结此类半椎体畸形的影像学特点。所有患儿均接受手术治疗,对比手术前后各项X线测量指标。结果本组患儿共计26个半椎体,主要分布于L 2以下,占总数的80.8%(21/26),10例患儿半椎体间隔1~2个正常椎体。半椎体和后方附件以协调型最为常见(21/26,80.8%)。患儿近端代偿弯(13.9°±7.2°)明显大于远端代偿弯(5.5°±5.0°)(P=0.04),腰椎前凸和胸椎后凸角分别为20.2°±15.0°和18.7°±9.2°。本组6例患儿发生骶骨倾斜,7例胸腰段前凸。CT和MRI检查发现6例(46.2%)合并其他部位畸形。11例分期或一期切除半椎体行短节段融合固定,2例一期切除2个半椎体同时行长节段融合固定。所有患儿均顺利完成手术,无神经损伤、伤口感染、内固定失效等并发症。术后随访(42.4±10.2)个月,末次随访时患儿节段性侧凸角和近端代偿弯均较术前明显改善(均P<0.05),其矫正率分别为83.3%±15.6%和38.1%±10.4%;患儿远端代偿弯、骶骨倾斜角、胸椎后凸角较术前虽有改善,但差异均无统计学意义(均P>0.05),胸腰段前凸均已矫正。结论腰椎对称型半椎体主要分布于下腰椎,患儿畸形较为复杂,合并畸形的发生率较高,需根据病情制定个体化的手术方案。

Objective To analyze the imaging characteristics and surgical effect for symmetrical lumbar hemivertebrae in pediatric patients.Methods The data of 13 patients with hemivertebrae locating in the lumbar spine symmetrically were retrospectively analyzed,and all the patients were treated in Beijing Children′s Hospital from January 2015 to September 2021.The mean age of the patients was 6.2(2.9,9.3)years.There were 8 males and 5 females.The data of coronal/sagittal plane including segmental Cobb angle,cranial/caudal compensatory curve,thoracic kyphosis,thoracolumbar kyphosis,sacral obliquity,and lumbar lordosis were recorded through long cassette spinal radiographs.Associated anomalies and the relationship between hemivertebrae and posterior component were recorded through computerized tomography(CT)and magnetic resonance imaging(MRI).All the patients received surgery,and their pre-and postoperative imaging data were compared.Results A total of 26 hemivertebraes were found,in which 80.8%(21/26)located below L 2.Hemivertebraes in 10 patients were separated by a mean 1-2 normal vertebrae.Most hemivertebraes along with the corresponding posterior component were unison(21/26,80.8%).The Cobb angles of cranial compensatory curve(13.9°±7.2°)was more serious than that of caudal compensatory curve(5.5°±5.0°)(P=0.04).The lumbar lordosis and thoracic kyphosis was 20.2°±15.0°and 18.7°±9.2°,respectively.Six patients complicated with sacral obliquity,while 7 patients complicated with thoracolumbar lordosis.Associated anomalies were found in 6(46.2%)patients through CT and MRI.Eleven patients received one-or two-stage posterior hemivertebrae resection with short segmental fusion,and 2 patients received one-stage hemivertebrae resection with long segmental fusion.All the surgery were completed successfully without serious complications such as nerve injury,infection,and implant failure.The mean follow-up period was(42.4±10.2)months.At the last follow-up point,the correction rate of segmental Cobb angle and cranial compensatory curve was 83.3%±15.6%and 38.1%±10.4%,respectively,showing significant improvement(P<0.05).Although the caudal compensatory curve,sacral obliquity,and thoracic kyphosis improved after surgery,the data showed no significant difference compared to that before surgery.Thoracolumbar lordosis in all patients were corrected.Conclusions Most hemivertebraes in such spinal deformity locate in lower lumbar region with a high incidence of anomalies.Individualized treatment based on patients′condition is essential for the complicated spinal deformity.