后路半椎体切除椎弓根螺钉内固定治疗小儿先天性脊柱畸形

Posterior hemivertebra resection combined with transpedicular instrumentation for the surgical treatment of congenital spinal deformity in children

目的:评价后路半椎体切除、椎弓根螺钉内固定治疗小儿先天性脊柱畸形的临床疗效。方法:2003年6月～2005年6月应用后路半椎体切除、椎弓根螺钉内固定和自体骨短节段植骨融合治疗28例小儿先天性脊柱侧凸畸形患者,男10例,女18例,年龄1.6～7岁,平均3.8岁。完全分节半椎体24例,半椎体伴对侧分节障碍4例。术后定期复查脊柱X线片,观察脊柱融合、畸形矫正率及内固定稳定情况。结果:术中发生胸膜损伤和脑脊液漏各1例,分别经胸腔和伤口引流痊愈;术后切口浅表感染1例,经抗炎和换药处理治愈;无神经系统损伤。随访23～48个月,平均35个月,术前主弯冠状面Cobb角平均为35.2°±2.2°,术后为5.2°±1.2°,末次随访为7.4°±1.1°,丢失2.2°;后凸角平均为26.2°±3.1°,术后为4.2°±0.8°,末次随访为4.8°±1.0°,丢失0.6°;均获得良好骨融合,融合时间3～6个月,平均4.2个月;无内固定失败及假关节形成。结论:后路半椎体切除、椎弓根螺钉内固定植骨融合能安全有效地矫正小儿先天性脊柱侧凸畸形,并能达到稳定的短节段内固定及优良的融合效果。

Objective：To evaluate the clinical efficacy of posterior hemivertebra resection combined with transpedicular instrumentation for the surgical treatment of congenital spinal deformity in children.Method： From June 2003 to June 2005,28 consecutive cases of young children with congenital scoliosis were treated by posterior hemivertebra resection combined with transpedicular instrumentation.There were 10 males and 18 females with an average age 3.8 years old （range,l.6 to 7 years ）.Segmented hemivertebra had 24 cases,and hemivertebra with unilateral bar had 4 cases.The X-ray was taken postoperatively at regular time,the status of the spinal fusion,correction rate and instrumentation were evaluated.Result：One case occurred injury of pleura,one case had leakage of cerebrospinal fluid,the above complications were cured by the drainage of thoracic cavity and incision respectively.One case occurred superficial incision infection which was cured by antibiotics and change dressings,no neurological injury was found.All cases were followed up from 23 to 48 months with an average of 35 months.Mean Cobb angle of the main curve was 35.2^o±2.2^o before surgery,5.2^o ±1.2^o after surgery,and 7.4^o±1.1^o at the final follow up with a 2.2^o loss of correction.Mean kyphotic angle was 26.2^o±3.1^o before surgery,4.2^o±0.8^o after surgery,and 4.8^o±1.0^o at the final follow up with a 0.6^o loss of correction,no hardware failure and pseudoarthrosis.Conclusion：Posterior hemivertebra resection combined with transpedicular instrumentation is an effective and safe surgical method for the treatment of congenital scoliosis in children.It can achieve a good stability of short segment fixation and fine spinal fusion.