大块自体骨原位椎间植骨融合技术在儿童半椎体切除术中的应用研究

Autologous bone graft in situ as anterior reconstruction after posterior hemivertebra resection for congenital kyphoscoliosis

目的探讨大块自体骨原位椎间植骨融合技术在儿童半椎体切除术中的应用及效果。方法回顾性分析首都医科大学附属北京儿童医院骨科2018年1月至2020年1月收治的70例因先天性半椎体畸形接受单节段半椎体切除术的患儿临床资料,按照手术方式分为对照组与观察组,对照组35例,采取传统后路半椎体切除植骨融合内固定术;观察组35例,采取后路半椎体切除、前方结构重建(大块自体骨原位椎间植骨)联合后方植骨融合固定术。收集两组患儿临床资料、手术及手术后随访情况。根据术前、术后及随访时站立位全脊柱正侧位X线片,测量相关矢状位和冠状位影像学参数,评估畸形矫正情况及治疗效果;通过随访过程中拍摄的脊柱CT片评估椎间及后方植骨融合情况。结果两组一般资料(性别、身高、年龄、体重、半椎体分布)差异无统计学意义(P>0.05);手术时间、术中出血量、住院日差异无统计学意义(P>0.05),术前冠状面参数(主弯Cobb角、近段代偿弯、远端代偿弯、冠状面平衡、骶骨倾斜角、骨盆倾斜角)及矢状面参数(节段性后凸角、胸椎后凸角、胸腰段后凸角、矢状面平衡、腰椎前凸角)差异亦无统计学意义(P>0.05)。两组术后1个月及末次随访时矢状面和冠状面参数较术前均有明显改善(P>0.05),但组间对比发现,末次随访时观察组主弯Cobb角和节段性后凸角的丢失较对照组明显要少,分别为(0.6±1.7)°比(2.7±2.9)°、(0.6±2.2)°比(3.2±3.9)°,差异均有统计学意义(P<0.05);术后12个月复查CT显示,观察组1级椎间融合率较对照组更高(68.6%比28.6%),差异有统计学意义(P<0.05);两组均无一例发生手术相关并发症。结论大块自体骨原位椎间植骨融合技术可通过前方骨块的支撑与重建,获得满意的椎间融合,矫正效果良好,尤其对于腰椎前凸角度的重建有优势。由于前方椎间的支撑与融合,从长期来看,更利于术后侧后凸角度的维持,可避免矫形角度的过多丢失。

Objective To explore the application of intervertebral autologous bone graft in situ in hemivertebral resection surgery in children.Methods A retrospective study was conducted for 70 children undergoing single-level hemivertebral resection due to congenital scoliosis.According to different surgical approaches,they were divided into control group and observation group(n=35 each).The control group underwent traditional posterior hemivertebral resection,bone grafting,fusion and internal fixation.The observation group underwent posterior hemivertebral resection,anterior structural reconstruction(massive autologous bone graft in situ for intervertebral fusion)and posterior bone grafting.Clinical data,surgical findings and postoperative follow-ups were recorded.Based upon radiographs of whole spine at the time of pre-operation,post-operation and follow-ups,the relevant sagittal and coronal imaging parameters were measured.Postoperative spinal computed tomography(CT)images were acquired during follow-ups for evaluating the outcomes of bone graft fusion.Results No inter-group statistical difference existed in gender,height,age,weight,hemivertebral distribution,operative duration,intraoperative blood loss or length of hospitalization stay(P>0.05).Preoperative coronal parameters(major curve Cobb's angle,proximal compensatory curve&distal compensatory curve)or sagittal plane parameters(segmental kyphosis angle,thoracic kyphosis angle,thoracolumbar kyphosis angle,sagittal plane balance&lumbar lordorsis angle)showed no significant difference(P>0.05).At the last follow-up,loss of major curve Cobb's angle and segmental kyphosis angle were significantly smaller in observation group than those in control group,which had significant differences(P<0.05);CT scan revealed that the rate of intervertebral fusion(level 1)was higher in observation group with a statistical difference(P<0.05);no obvious operation-related complications occurred in neither groups.Conclusion In situ intervertebral bone grafting of massive autogenous bone may achieve excellent correction and satisfactory intervertebral fusion through anterior support and reconstruction,which has significant advantages for the correction of lumbar lordosis.At the same time,due to anterior intervertebral support and fusion,it is more benefical to maintain postoperative kyphosis angle and avoid excessive angle loss.