Apofix器械矫正经后路切除的半椎体畸形

Posterior hemivertebra excision and correction with Apofix instrumentation

目的 介绍经脊柱后路Ⅰ期切除半椎体及椎板夹凸侧加压治疗完全分节型半椎体畸形的方法。方法 经C臂机精确定位后 ,先切除半椎体的棘突、椎板等后半部分 ,打开肋横关节 ,从横突外侧剪断肋骨 ,逐渐挖除椎体松质骨 ,作椎体间的植骨融合。将具有伸缩性可加长的“[”型Apofix内固定器植入椎板下 ,逐渐压缩“[”型装置 ,进行清醒试验并沿着器械区域作凸侧椎板植骨融合。结果 7例患儿 8个单纯性半椎体 ,患儿平均年龄 7岁 ,半椎体位置包括下胸椎 (T10 )到下腰椎 (L3 ) ,术前Cobb角 2 2°～ 6 0° ,平均 39.3° ,术后矫正至 3°～ 30° ,平均 18.8° ,矫正率为 5 2 .0 %。随访时间 7～19个月 ,平均 12个月 ,最终随访的Cobb角 5°～ 33° ,平均 17.8°。结论 从脊柱后方入路不仅能Ⅰ期完整地切除半椎体 ,而且免除了前路手术创伤 。

Objective To explore the possibility of using posterior resection of the hemivertebra and achieve correction of deformity with a laminar clip (Apofix instrumentation) for fully segmented and unincarcerated hemivertebra.Methods After localization, the costotransverse joint connected with hemivertebra was incised. The ribs were cut laterally from the transverse process. Then the joint of capitulum costae was freed to expose the lateral vertebral body. Periosteum was detached by laterally inserting gauze. Then the spongy bone and intervertebral disc was removed. Finally the flexible Apofix internal fixiation device was implanted under the lamina of vertebra.Results There were 7 patients (including 8 hemivertebra) in this series. The mean age of the patients was 7 years, ranging 4～10 years. Hemivertebra levels were from T10 to L3. The average preoperative curve measured 39.3°(ranging 22°～60°). Immediate postoperative curves averaged 18.80(ranging 3°～30°). The amount of curve correction averaged 52%. 7 patients were followed-up for a mean of period 12 months (ranging 7～19 months). Last curves averaged 17.8° (5°-33°).Conclusions The posterior approach can not only achieve complete removal of hemivertebra in a single stage but also avoid severe trauma associated with anterior route and prevent the nerve injury caused by change of body position.