半椎体切除术治疗先天性腰骶弯

Hemivertebrae Resection in the Treatment of Congenital Lumbosacral Scoliosis

目的探讨腰骶段半椎体手术治疗策略。方法本科2001年1月至2010年1月共收治了877例先天性脊柱侧凸患者,其中腰骶段半椎体所致先天性脊柱侧凸8例。通过术前、术后及随访时X线片,对这8例患者的半椎体特点、手术方式、侧凸冠状面Cobb角、矢状面Cobb角、躯干偏移进行回顾性分析。结果完全分节型半椎体5例,部分分节型半椎体3例。一期前后路半椎体切除1例,一期后路半椎体切除7例。手术出血量200～2300ml,平均692ml;手术时间平均6.5h。短节段固定6例,长节段固定2例。手术前后及末次随访时腰骶弯冠状面Cobb角分别平均为33.1°、9.8°和14.0°,术后即刻矫正率为70.4%,最终矫形率为57.7%;手术前后和末次随访时近端腰弯冠状面Cobb角分别平均为32.5°、12.6°和14.2°,术后即刻矫正率为61.2%,最终矫形率为56.3%。术前4例患者有冠状面躯干失平衡。全部病例随访12～82个月,平均30.9个月。并发症包括伤口裂开1例,椎弓根螺钉位置不良2例,一过性神经根损伤1例,其中1例行翻修手术。最终随访时7例患者冠状面躯干偏移改善,1例患者发生冠状面躯干失平衡加重,无矢状面失平衡发生。结论腰骶段半椎体畸形可引起明显的冠状面躯干失平衡,应及早手术治疗。早期病例往往畸形较轻,可采用半椎体切除+短节段固定融合术。如果畸形较重或代偿弯较明显则需要延长融合范围。

Objective To summarize the surgical treatment results and discuss the surgical strategy of congenital scoliosis due to lumbosacral hemivertebrae.Methods Totally 877 patients with congenital scoliosis were treated in our hospital between January 2001 and January 2010.Among them,there were 8 cases of lumbosacral hemivertebrae（3 males and 5 females,with the average age at surgery of 11 years old）.The clinical data including the anatomic data of hemivertebrae,coronal and saggital Cobb angle,coronal and sagittal trunk shift,surgical approach,and fusion area were retrospectively analyzed for these 8 patients.Results There were 5 full-segmented hemivertebrae and 3 semi-segmented hemivertebrae.Seven patients underwent hemivertebrae resection with posterior approach only,1 patients underwent hemivertebrae resection with one-stage anterior and posterior approach.The intra-operative blood loss ranged 200-2300 ml（mean：692 ml）.The average operation time was 6.5 h.Six patients had short segment fixation and 2 patients had long segment fixation.The mean coronal Cobb angle of lumbosacral curve was 33.1° before surgery,9.8° after surgery,and 14.0°at latest follow-up.The mean coronal Cobb angle of proximal lumbar curve was 32.5°before surgery,12.6°after surgery,and 14.2°at latest follow-up.Four patients had coronal trunk imbalance before surgery.The complications included wound dehiscence（n=1）and nerve root injury（n=1）.Two patients had malpostion of pedicle screw.One revision surgery was performed.All patients were followed up from 12 to 82 months,with an average follow-up duration of 30.9 months.Coronal trunk shift was improved in 7 patients after surgery,1 patient had coronal trunk decompensation at final follow-up,and no saggital trunk decompensation was noted.Conclusions Lumbosacral hemivertebrae may cause scoliosis with obvious coronal trunk imbalance,which needs early intervention.The early surgery with hemivertebrae resection and short segment fixation is able to avert severe local deformity and prevent secondary deformity.If the compensatory lumbar curve is severe,extensive fusion is preferred.