后路一期半椎体切除节段性内固定融合治疗先天性脊柱侧凸

The Treatment of Hemivertebra Resection via the Posterior Approach along with Segments Internal Fixation for Congenital Kyphoscoliosis

目的探讨合并有半椎体畸形的脊柱侧后凸患者的手术矫正策略和方法，并对手术矫正效果进行评估．方法2010年6月至2011年6月，共收治合并半椎体畸形的脊柱侧后凸患者6例，男4例，女2例，平均年龄15．7岁（12～20．6岁）．侧凸Cobb角平均73．4°（52°～87°），节段性后凸角平均67．4°（430～890）．切除的半椎体最高T9，最低L2．对于无结构性代偿弯曲的2例患者行后路经椎弓根半椎体切除、短节段椎弓根螺钉固定术；对于合并结构性代偿弯的4例患者行后路经椎弓根半椎体切除、长节段矫形代偿弯固定融合术．结果手术时间2．5—4．0h，平均3．5h；术中出血700—2000mL，平均1367mL．术后出现单侧下肢麻木者1例，1月后完全缓解，无其他术中、术后并发症发生．术后侧凸平均21．40（110～280），矫正率67．9％；术后后凸平均17．8°（12°～35°），矫正率72．5％．平均随访26个月（24—36个月），未发现假关节形成．后凸和侧凸无明显丢失．结论半椎体切除和采取个性化的手术方案治疗先天性脊柱侧后凸可以起到很好的矫正效果．

Objective To study the surgical strategies and techniques for the correction of congenital kyphoscoliosis with hemivertebra and evaluate the surgical results. Methods From June 2010 to June 2011, there were 6 congenital kyphoscoliostic patients with fully segmented hemivertebra were undergone hemivertebra resection through posterior approach, which included 4 males and 2 females with an average age of 15.7 years. The average Cobb angle of scoliosis was 73.4° （range, 52° -87° ）, the average Cobb angle of segmental kyphosis was 67.4° （range, 43°-89° ） . The highest level of hemivertebrae was T9 and the lowest was L2. The surgical strategies were designed as followed： For the 2 cases without structural compensative curve, the posterior hemiverte- brae resection and short segmental internal fixation were performed. For the 4 cases with structural compensative curve, whose Risser signs were classified into 2-5, the hemivertebrae resection and long segmental internal fixa- tion were performed, and the compensative curve was included in the instrumentation level. Results The opera- tion time was 2.5 - 4.0 h （average, 3.5 hours） , the blood loss was 700-2 000 mL （mean, 1 367 mL） . Numb- ness happened in one lower extremity postoperatively in 1 patient, and the symptom released in 1 month. The aver- age postoperative Cobb angle in coronal plane was 21.4° （11 °-28° ） with a correction rate of 67.9%. The aver- age postoperative Cobb angle in sagittal plane was 17.8° （12° -35° ） with a correction rate of 75.2%. The fol- low-up period was from 26 months to 36 months （average, 26 months） , no pseudoarthrosis, and obvious eorrec-tion loss either in coronal or sagittal plane was noted. Conclusion Hemivertebra resection and individualized oper- ation way has a good capability of correcting congenital kyphoscoliosis caused by hemivertebra.