一期前后路半椎体切除节段性内固定治疗小儿先天性脊柱侧凸

One-stage anteroposterior hemi-vertebra resection and segmental internal fixation for young children with congenital scoliosis

目的 探讨一期前后路半椎体切除节段性内固定治疗小儿先天性脊柱侧凸的可行性及疗效.方法 回顾性分析35例半椎体所致的先天性脊柱侧凸,所有病例均施行了一期前后路半椎体切除节段性内固定术,并且获得1.2～8.7年的随访（平均5.3年）,主要比较患儿手术前后Cobb＇s角的变化.结果 术前脊柱侧凸Cobb＇s角为（42.5±6.7）°,术后纠正到（16.2±3.2）°,平均纠正率64.7%.14例明显后凸的Cobb＇s角由（33.5±5.2）°纠正到（13.3±5.6）°,平均纠正率53.2%.手术时间210～280 min,平均240 min.术中出血量80～200 ml,平均120 ml.最后随访时侧凸和后凸分别为（15.6±5.8）°和（14.2±3.3）°,与术后相比,无纠正丢失.无死亡和神经系统并发症.未发现内固定松动及断裂现象.结论 一期前后路半椎体切除节段性内固定是治疗小儿先天性脊柱侧凸的有效术式,能够通过较短节段的融合获得满意的矫正.

Objective To discuss the feasibility and efficacy of one-stage anteroposterior hemivertebra resection and segmental internal fixation for young children with congenital scoliosis. Methods Thirty-five patients undergoing one-stage anteroposterior hemi-vertebra resection and segmental internal fixation were retrospectively studied. The mean followed-up period was 5.3 years （ range： 1.2 - 8.7）. The Cobb＇s angle of scoliosis at pre and post-operation was compared. Results All children＇s parents were satisfied with the outcome. The Cobb＇ s angle of scoliosis was corrected from （42.5 ± 6.7 ）° to （ 16.2 ±3.2）° at post-operation. The coronal correction rate was 64.7%. The angle of kyphosis improved from preoperative（33.5 ± 5.2）° to postoperative （ 13.3 ± 5.6）° in 14 cases. Operative duration was 210 - 280 minutes with an average of 240 minutes. The intra-operative blood loss was 80 -200 ml with an average of 120 ml. There was no significant correction loss at follow-up. No neurological complication, infection or pedicular fracture was reported. Conclusion The procedure of one-stage anteroposterior hemi-vertebra resection and segmental internal fixation is a safe and effective treatment for scoliosis by congenital hemivertebra in young children. A satisfactory correction may be achieved with a short fusion segment.