胸椎半椎体畸形合并脊髓纵裂的手术治疗

Surgical treatment of thoracic hemivertebra and diastematomyelia

目的：探讨胸椎先天性半椎体脊柱侧凸畸形合并脊髓纵裂的手术治疗方法。方法：2003年1月至2007年6月．共收治10例先天性半椎体脊柱侧凸畸形合并脊髓纵裂患者，男4例，女6例，年龄16-22岁，平均17．4岁。均为单个完全分节半椎体，病变位于T11 3例，T12 7例。采用一期后路半椎体及骨性分隔切除内固定矫形治疗．定期随访患者，评价术后矫正率。结果：10例患者均获得有效半椎体及骨性分隔切除，无神经损伤，术前侧凸Cobb角为40°-86°，平均53．6°；术后Cobb角为5°-28°，平均16．5°，侧凸矫正率平均69．3％。随访9～45个月，平均32个月，术后3．5个月截骨间隙达到骨性融合，无内固定失败及假关节形成。末次随访时有1．6°角度丢失。结论：应用一期后路半椎体及骨性分隔切除内固定矫形治疗先天性半椎体脊柱侧凸畸形伴脊髓纵裂效果满意．近期疗效可靠。

Objective：To discuss surgical treatment of scoliosis of thoracic hemivertebra and diastematomyelia. Method：10 patients were treated by one-stage posterior hemivertebra and osseous dividing resection combined with transpedicular instrumentation and bone graft.There were 4 males and 6 females with an average age of 17.4 years （range,16 to 22 years）.All cases were single complete segmented hemivertebra.Hemivertebra were located at T11 （n=3） and T12 （n=7）.The correction rate was evaluated after surgery.Result：All cases were followed up 9 to 45 months with an average of 32 months.Mean Cobb angle of the main curve was 53.6°（range,40° to 86°） before surgery,it was 16.5°（range,5° to 28°） after surgery.The mean correction rate was 69.3%.At the final follow-up the loss of correction was 2.6°.The bone grafting showed good bony fusion. The time of vertebra fusion was 3 to 5 months.No instrumentation, spinal fusion failure or other severe complications were noted.Conclusion：One-stage posterior hemivertehra and osseous dividing resection combined with transpedicular instrumentation and bone graft can provide a satisfactory result for the treatment of scoliosis of thoracic hemivertebra and diastematomyelia.