后路一期半椎体切除单节段融合治疗先天性脊柱侧凸的疗效及其并发症

The efficacy and complications of posterior hemivertebra resection with monosegmental fusion forcongenital scoliosis

【目的评价后路一期半椎体切除单节段融合治疗半椎体所致先天性脊柱侧凸的临床效果。方法回顾性分析2003年2月至2008年9月30例接受手术治疗的半椎体所致先天性脊柱侧凸的患者临床资料，其中女性15例，男性15例，年龄2～16岁，平均6．0岁。所有病例均行后路一期半椎体切除，均应用椎弓根螺钉技术行单节段固定，术前、术后及随访时均行站立位全脊柱正侧位X线片检查，对冠状面和矢状面Cobb角、躯干偏移进行测量分析。同时复习病历，统计手术时间、出血量以及并发症情况。结果30例患者手术时间120—400rain，平均193．8rain；出血量80～1000rnl，平均369．0ml；随访24—90个月，平均46．6个月。冠状面主弯Cobb角术前平均36．4。，术后4．0。，末次随访4．9。，矫正率为86．5％；头侧代偿弯冠状面Cobb角术前平均17．5。，术后6．8。，末次随访4．4。，矫正率为74．9％；尾侧代偿弯冠状面Cobb角术前平均19．3。，术后5．5。，末次随访4．8。，矫正率为75．1％；躯干偏移术前平均17．1mm，术后14．6mm，末次随访8．8mm；矢状面节段后凸Cobb角同正常值的差距术前平均21．2°，术后6．9°，末次随访6．6°，矫正率为68．9％。有2例患者手术后出现椎弓根螺钉切割，1例术后畸形进展，翻修后断棒，1例出现伤口延迟愈合，有2例患者随访发现截骨间隙仍呈低密度“透亮带”，但无假关节以及内固定失败发生。结论后路一期半椎体切除单节段融合可早期去除先天性脊柱侧凸病因，在矫正原发畸形的同时可以减少继发畸形的出现，可保留更多的活动节段。但螺钉切割等内固定失败可能性大。

Objective To evaluate the efficacy and complications of posterior hemivertebra resection with monosegmental fusion in the treatment of congenital scoliosis. Methods Thirty consecutive cases of congenital scoliosis managed by posterior hemivertebra resection with monosegmental fusion of the two adjacent vertebra were investigated retrospectively. Radiographs were reviewed to determine the coronal curve magnitude and sagittal alignment preoperatively, postoperatively and at last follow-up. Operative reports and patient charts were reviewed to record any perioperative and late complications. Results The total number of resected hemivertebra was 30. Mean operation time was 193.8 min with average blood loss of 369.0 ml. The segmental scoliosis was corrected from 36. 4° to 4. 9°with a correction rate of 86. 5% , and segmental kyphosis（difference to normal segmental alignment） from 21.2° to 6.6° with a correction rate of 68.9%. The trunk shift was improved from 17.1 to 8. 8 mm. The correction of the compensatory cranial and caudal curve were 74.9% and 75.1%. There were 1 delayed wound healing, 2 pedicle cutting and 1 rod breakages. Radiolucent gaps were found on the lateral view in 2 cases without any sign of implant failure and correction loss. Conclusions Posterior hemivertebra resection with monosegmental fusion of the two adjacent vertebra allows for early intervention in very young children. Excellent correction in the frontal and sagittal planes can be obtained. And a short segment of fusion allows for normal growth in the unaffected parts of the spine. The most common complication is implant failure.