后路矫形固定融合治疗先天性脊柱侧后凸畸形的疗效分析

Analysis on operative effect of posterior instrumentation and fusion for the surgical treatment of congenital kyphoscoliosis

[目的]回顾性分析15例先天性脊柱侧后凸畸形经后路矫形植骨固定矫正术的治疗效果。[方法]2002年7月～2008年8月,先天性脊柱侧后凸患者15例,男8例,女7例;平均年龄11.6岁。术前拍摄站立位的脊柱正侧位X线片及左右Bending位X线片、CT及全脊柱MRI;其中,先天性半椎体11例,Chiari畸形/脊髓空洞症3例,神经纤维瘤病1例。侧凸Cobb’s角平均78°(35°～156°),后凸平均25°(15°～38°)。对于先天性半椎体引起脊柱侧后凸畸形的患者9例行后路经椎弓根半椎体切除、椎弓根螺钉(美国,史赛克)固定术,2例行后路长节段矫形卢氏环内固定融合术;对于Chiari畸形/脊髓空洞症的3例及神经纤维瘤病1例患者行后路长节段矫形代偿弯固定融合术。[结果]平均手术时间5.5h(3.5～7.5h);平均术中出血850ml(300～2100ml);平均随访43个月(10～82个月),术后侧凸平均28°(11°～38°),矫正率64%;术后后凸平均16°(7°～33°),矫正率36%,均骨性融合;1例神经纤维瘤病患者术中发生大出血,经大量输血后,病情平稳。长期随访发现内固定断裂3例,曲轴现象2例,但无其他术后并发症发生。[结论]先天性脊柱侧后突畸形是复杂的骨骼神经肌肉系统疾病,应针对不同的病因采用个体化治疗方案;其中,半椎体切除短节段椎弓根钉内固定植骨融合对先天性半椎体畸形是有效、安全的方法。

[Objective]To evaluate the surgical effect of posterior correction and instrumentation on the treatment of congenital kyphoscolosis deformity. [Methods]From july 2002 to august 2007,there were 15 congenital kyphoscoliotic patients,which included 8 males and 7 females with an average age of 11.6 years.The average Cobb’s angle of scoliosis was 78°（35°~156°）,the average Cobb’s angle of kyphosis was 25°（15°~38°）.For the 9 kyphoscolsis patients with hemivertebra,hemivertebra resection and intervertebral fusion and fixation with pedicle screw instrument system were used,Luque’s systems was used in 2 cases,for the 3 cases accompanied with Chiari malformation and/or syringomyelia and 1 case with neurofibroma,posterior correction and long segmental pedicle screw fixation were performed and the compensative curve was included in the instrumentation level.[Results]The operation time was 3.5~7.5 h （average,5.5 h ）,the blood loss was 300~2 100 ml （mean,850 ml）;the average follow-up was 43 months （10~82 months）,and the radiographs taken from standing posteroanterior position and lateral side showed that the mean Cobb’s angle of scoliosis was corrected from preoperative 78° to postoperative 28°（11°~38°）,with a correction rate of 64%.Postoperatively ,the angle of kyphosis was improved from the preoperative 25° to 16°（ 7°~33°）,with a correction rate of 36%.Solid fusion was achieved in all 15 cases of patients. But significant blood loss occurred in the operative procedure of neurofibroma. And long term follow-up showed 3 cases of rod fracture,1 case of crankshaft phenomenon.[Conclusion]The congenital kyphoscolosis deformity is a kind of complex syndrome concerning skeleton-muscle-nerve system,aim to different cause,strategy of treatment should be individualized.The posterior hemivertebral resection and correction is a safe and effective method for the prepubertal children with the congenital hemivertebrae deformity.