后路半脊椎切除治疗小儿先天性脊柱侧弯

Hemivertebra resection by posterior approach for correction of congenital scoliosis in children

目的:讨论小儿先天性脊柱侧弯的早期手术治疗方法及效果.材料及方法:2000年4月～2002年6月得到随访的采用后路半脊椎不同切除方法治疗的小儿先天性脊椎侧弯11例,全部病例未行器械内固定,其中先天性脊柱侧弯Ⅰ型未闭型6例,混合型5例(全部为一侧Ⅰ型未闭型对侧Ⅱ型).半椎体位于中胸段1例,胸腰段7例、腰段1例、腰骶段1例,中胸段及胸腰段同时存在1例.年龄3个月～2.5岁 8例,4～10岁3例,男6例,女5例.4例患儿合并脊髓栓系综合征.采用后路蛋壳样半脊椎切除治疗的小儿先天性脊椎侧弯2例,后路半脊椎全切或同时上下骺板阻止术治疗者8例.术后支具固定4～6个月.随访时间6个月～2 年7个月.结果:术前Cobb角最小25°,最大56°,平均39°,术后矫正率最大61.5%,最小负6.1%,平均24.4%.无脊髓损伤及切口感染等并发症.结论:Ⅰ型未闭型半椎体采用后路蛋壳样切除或后路全切可以达到满意的效果,混合型必须采用后路半脊椎切除加上下骺板阻止术才能达到满意效果.后路半脊椎切除不用器械内固定方法简单,损伤小,并发症少,初步随访显示疗效好,是治疗婴幼儿或轻度先天性脊柱侧弯值得推荐的手术方法.

Objective:To study the operative methods and results in children with congenital scoliosis by hemivertebra excision through posterior approach.Method:For this study,11 consecutive cases of congenital scoliosis managed by hemivertebra resection using a posterior approach without transpedicular instrumentation were investigated retrospectively,with at least 6 month follow up period.Surgery was performed in patients who had congenital scoliosis with proven or expected deterioration.Result:The mean Cobb's angle of the main curve was 39 degrees(25～56 degrees)before surgery,30 degrees(15～52 degrees)at the latest follow up assessment,yielding average corrections of 24.4%(-6.1%～61.5%).There were no infection,no trauma of spinal cord and other severe complications.Conclusion:Posterior resection of hemivertebrae without transpedicular instrumentation is a safe and promising procedure that offers significant advantages for controlling congenital scoliosis:excellent correction in both the frontal and sagittal planes,short segment of fusion,high stability,no need for an anterior approach,and low neurologic risk.Surgery should be performed as early as possible to avoid severe local deformities,to prevent secondary structural changes,and to avoid extensive fusions.