经椎弓根椎体去松质骨切除治疗儿童胸腰段半椎体并侧后凸畸形

Treatment of children with thoracolumbar hemivertebrae and kyphoscoliosis deformity by cancellous bone resection through pedicle vertebra

目的观察经椎弓根椎体去松质骨切除治疗儿童胸腰段半椎体并侧后凸畸形的临床效果。方法对自2006年12月-2011年6月收治的儿童胸腰段半椎体并侧后凸畸形7例均行经椎弓根椎体去松质骨切除内固定植骨融合治疗。结果随访6—48个月，平均（24．8＋3．5）个月。手术时间160—200min，平均（1823：25）min。术中出血量1200—2000ml，平均（15203：200）ml。固定融合节段4～10节。脊柱侧凸Cobb角由术前平均（50．5±16．3）。矫正到术后1个月（16．7±5．4），后凸Cobb角由术前平均（48．93±21．5）。矫正到术后1个月（19．83：10．7），3例有神经系统损伤者平均JOA评分由术前（8．0±1．6）分提高到末次随访时（24．03：1．5）分。结论儿童胸腰段半椎体并侧后凸畸形应尽早手术干预，经椎弓根椎体去松质骨切除技术能达到满意矫正效果，同时减少并发症的发生。

Objective To observe the clinical efficacy of the treatment of children with thoracolumbar hemivertebrae and kyphoscoliosis deformity by cancellous bone resection through pedicle vertebra. Methods Seven children with thoracolumbar hemivertebrae and kyphoscoliosis deformity from December 2006 to June 2011 were treated in our hospital. The cancellous bone resection through pedicle vertebra, internal fixation and bone graft fusion were performed. Results They were followed up for 6 to 48 months, an average of （24.8~3.5）months. The operative time was 160 to 200min, an average of （182＋25）min.The amount of bleeding in surgery was 1200 to 2000 ml, an average of （1520＋200）ml. The fixed fusion segments were 4 to 10. After one month the scoliosis Cobb angle was corrected from preoperative average of （50.5~16.3）~ to postoperative （16.7~ 5.4）~, the kyphosis Cobb angle was corrected from preoperative average of （48.9~21.5）~ to postoperative （19.8~10.7）~ and the average JOA score of three patients with nervous system damage was increased from preoperative （8.0~1.6）points to final following （24.0＋1.5）points. Conclusion Children with thoracolumbar hemivertebrae and kyphoscoliosis deformity should be surgically interfevened as soon as possible. The cancellous bone resection through pedicle vertebra can achieve an effective correction effect and reduce the incidence of complications.