后路一期半椎体切除治疗脊柱上胸段侧后凸畸形

Posterior hemivertebra resection in the treatment of congenital upper thoracic deformity caused by hemivertebra

目的:观察后路一期半椎体切除、内固定植骨融合治疗上胸段侧后凸畸形的临床效果。方法 :2005年12月～2010年2月我院共收治半椎体所致脊柱上胸段侧后凸畸形患者8例,男4例,女4例;年龄11～15岁,平均13岁。3例患者合并神经系统症状。均行后路一期半椎体切除内固定植骨融合术,术前、术后和随访时拍摄站立位脊柱正侧位X线片,测量冠状面与矢状面局部后凸Cobb角;记录围手术期并发症;通过JOA评分评价术前、术后1周及末次随访时神经系统症状的改善情况。结果:全部病例随访6～50个月,平均22.8个月。手术时间150～420min,平均278min。术中出血量500～3500ml,平均1787ml。固定融合节段4～11节,平均8.5节。冠状面局部侧凸Cobb角由术前平均45.5°矫正至术后1周的14.4°;矢状面局部后凸Cobb角由术前平均47.9°矫正至术后1周的21.6°;3例合并神经系统损伤患者平均JOA评分由术前5分提高到末次随访时的8分。1例连接器固定患者术后10个月随访时发现细棒断裂,翻修后随访24个月效果良好。结论:对于先天性脊柱上胸段畸形,后路一期半椎体切除、内固定植骨融合术可取得良好的治疗效果。

Objective：To evaluate the outcome of surgical treatment for congenital upper thoracic deformity.Method：There were 8 consecutive cases,4 males and 4 females,with the average age at surgery was 13 years ranging from 11 to 15 years.All patients had upper thoracic kyphosis and scoliosis,3 patients with neurologic deficit due to severe spinal deformity.Posterior hemivertebra resection and internal fixation was performed in all cases.Long cassette standing radiographs were taken before and after surgery and at the final follow-up.Correction of scoliosis,kyphosis,neurologic outcomes（JOA scores） and operative complications were recorded and analyzed.Result：The average follow-up was 22.8 months ranging from 6 to 50 months.The average operative time was 278min with a mean 1787ml of blood loss.The average fusion segments were 8.5,ranging from 4 to 11 segments.The scoliosis was corrected averagely from 45.5° to 14.4°.The kyphosis was corrected averagely from 47.9° to 21.6°.The average preoperative JOA score was 5 points,which was improved to 8 points at the final follow-up.Complications included rod broken in 1 case of domino connector extending between 3.5mm and 5.5mm rods.Conclusion：Posterior hemivertebra resection and internal fixation is a reasonable surgical option for congenital upper thoracic deformity caused by hemivertebra.