一期后路半椎体切除矫正内固定治疗先天性脊柱侧凸畸形

One stage posterior excision of hemivertebra combined with correction and internal fixation for the treatment of congenital scoliosis

目的探讨一期后路半椎体切除矫正植骨内固定术治疗先天性脊柱侧凸畸形的临床效果。方法 采用一期后路半椎体切除矫正植骨融合内固定术治疗先天性脊柱侧凸畸形患者12例。术中咬除半椎体的后部附属结构,沿椎弓根外侧壁骨膜下剥离至椎体前缘,显露并切除半椎体、上、下椎间盘及邻近椎体的软骨面,通过内固定器械凸侧加压闭合畸形椎切除所余空隙,矫正脊柱畸形。术后定期门诊复查,观察脊柱融合、畸形矫正率和内固定稳固情况。结果 本组11例获得随访,随访时间1年3个月～6年5个月,平均3年4月,术前侧凸Cobb's角32～75°,平均57°,术后Cobb's角11～30°,平均17°,矫正率为57.7%;术前后凸25～65°,平均45°,术后后凸8～15°,平均14.5°,矫正率为61.7%。10例均无长期并发症,1例术后出现同侧下肢神经功能受损症状,保守治疗后恢复正常。结论 先天性脊柱侧凸患者绝大多数都呈进行性发展的自然病程,一期后路半椎体切除矫正植骨融合内固定术,固定节段短,创伤小,可以起到很好的矫正效果。

Objective To evaluate the clinical results of one stage posterior excision of hemivertebra combined with correction and internal fixation in treatment of congenital scoliosis.Method Twelue cases of congenital scoliosis from May 2001 to January 2009 were retrospectively analyzed.Among the patients,5 were male and 7 were female.The average age at surgery was 11.4 years ranging from 5 to 16 years.There were 8 cases with fully segmented hemivertebra and 4 cases with partial segmented hemivertebra.The congenital scoliosis patients were undergone one stage hemivertebra excision through open posterior approach combined with correction and internal fixation.Result Eleuen cases were successfully followedup.The average follow-up time was 3 years and 4 months ranging from 1 year and 3 months to 6 years and 5 months.The average Cobb＇s angle in coronal plane was 57°ranging from 32°to 75°preoperatively,which was corrected to average 17°ranging from 11° to 30°postoperatively.The rate of correction was 57.7%.No permanent complication was observed.one case which had neurological deficit in homolateral thigh after surgery was totally recovered after 1 month of nerve nourishing treatment.Conclusion Most congenital scoliosis cases have natural progressive development history.One stage posterior excision of hemivertebra combined with correction and internal fixation fused short segment and had little injury,and good correction result could be expected.