一期前后路联合或单纯后路半椎体切除治疗先天性脊柱侧凸

Single-stage anterior-posterior or posterior-alone hemivertebra resection for congenital scoliosis

目的:探讨前后路联合或单纯后路半椎体切除术矫治先天性脊柱侧凸的有效性、安全性。方法:2003年4月～2007年8月共收治先天性脊柱侧后凸患者32例,平均年龄12.8岁(9～22岁),其中13例半椎体位于T9～L2,且其楔形底偏向腹侧,通过一期前后路联合手术切除半椎体矫形(前后路组);其余19例单发半椎体,位置在T10～L3,且其楔形底偏向背侧,行后路切除半椎体矫形(后路组),统计分析两组的手术时间、失血量、主弯矫正率和并发症。结果:前后路组平均手术时间5.4h,平均失血量580ml;后路组平均手术时间4.3h,平均失血量470ml,两组比较均有显著性差异(P<0.05)。前后路组和后路组平均术后矫正率分别为64.1%和63.7%,两组间无显著性差异(P>0.05)。随访11～37个月,平均18个月,两组矫正度数均无明显丢失,并发症均较少。结论:胸腰段孤立半椎体切除矫治先天性脊柱侧凸是有效的,术前认真检查判定半椎体楔形底的位置、结构,合理地选择入路,术中谨慎操作能保证半椎体切除的安全性。

Objective：To evaluate the efficacy and safety of single-stage anterior-posterior or posterior-alone hemivertebra resection for congenital scoliosis retrospectively.Method：From April 2003 to August 2007,32 congenital scoliosis patients undergoing single-stage anterior-posterior or posterior-alone hemivertebra resection were included in this study.The mean age at time of surgery was 12.8 years old （range,9 -22 years）.13 patients had hemivertebre at T9 -L2 with the bottom of hemivertebra orientated ventrally and underwent single-stage anterior-posterior hemivertebra resection（anterior-posterior group）,the other 19 patients had single hemivertebra at T10 -L3 with the bottom of hemivertebra orientated dorsally experienced single posterior surgery.The operation time,blood loss,correction rate of main curve and complication were reviewed and compared between 2 groups.Result：The mean operation time and blood loss for anterior-posterior group and posterior group was 5.4h/580ml and 4.3h/470ml respectively,which had significant difference （P 0.05）.The average correction rate of main curve for anterior-posterior group and posterior group was 64.1% and 63.7% （P 0.05） respectively.Follow-up period averaged 18 months.No significant loss of correction was found. Complication in 2 groups was rare.Conclusion：Hemivertebra resection in thoracolumbar region is effective for congenital scoliosis.Preoperative evaluation of hemivertebra and careful maneuver can ensure the procedure safe and successful.