小儿复杂性先天性脊柱侧凸二例分期手术的疗效分析

Staging surgery in treatment of complicated congenital scoliosis: report of 2 cases

目的探讨分期手术治疗小儿复杂性先天性脊柱侧凸的可行性及临床疗效。方法回顾性分析2006年7月和2013年1月山西医科大学第二医院骨科手术治疗的2例小儿复杂性先天性脊柱侧凸患者的临床资料,其中男、女性各1例,年龄分别为6岁和9岁。均采用分阶段手术治疗,术后在脊柱X线正、侧位片上,通过观察患儿躯干冠状面和矢状面的平衡改善情况、冠状面Cobb角的改善情况、肩部平衡的改善情况等,来评定治疗效果。结果患儿男一期手术后Cobb角从术前78°改善到术后40°,肩胛骨高度差缩小到6cm;二期手术后Cobb角改善到16°,肩胛骨高度差缩小到5cm,术后6年Cobb角改善到10°;三期肩胛骨下移术后双侧肩胛骨高度差缩小到2cm;术后8年Cobb角改善到10°,双侧肩胛骨高度差缩小到1cm。患儿女一期手术主胸弯Cobb角从术前53°改善到术后11°、腰弯Cobb角改善到21°,冠状面和矢状面均平衡,术后1年腰弯Cobb角增大到30°、冠状面出现失衡、C7铅垂线(C7PL)至骶骨中垂线(CSVL)距离为8cm;二期术后半年腰弯Cobb角改善到3°、C7PL至CSVL距离改善为4cm,术后1年腰弯Cobb角进一步改善到1°、C7PL至CSVL距离改善到3cm。2例均无手术并发症发生。结论分期手术治疗复杂性小儿先天性脊柱侧凸可操作性强、风险小、临床疗效好。

Objective To explore the feasibility and the clinical curative effect of staging surgery for pediatric complicated congenital scoliosis. Methods A retrospective study was made for 2 cases of pediatric complicated congenital scoliosis had received staging surgery from July 2006 to January 2013. The pre-operative and postoperative parameters such as coronal and sagittal balance, coronal Cobb angle, shoulder balance were measured to evaluate the therapeutic effect. Results Case A had been improved its Cobb angle from pre-operative 78° to postoperative 40° and been decreased the height difference of scapulas to 6 cm in first stage surgery, further improvement had been made for the Cobb angle was to 16° and the height difference of scapulas was to 5 cm in second stage surgery. From 6 to 8 years after surgery, the Cobb angle had been continuously improved to 16° and 10°. Case B had been improved its Cobb angle of main thoracic scoliosis from pre-operative 53° to postoperative 11°, and the lumber scoliosis had been improved from 31° to 21°, and the height difference of scapulas had been decreased to 6 cm in the first stage surgery, 1 year later lumber scoliosis increased to 30 ° and there was 8 cm coronal imbalance developed. After second stage surgery the distance from C7PL to CSVL decreased to 4 cm, and the lumber Cobb angle decreased to 3°, 1 year after the second stage surgery the lumber Cobb angle had continuously improved to 1 °, distance from C7PL to CSVL continuously decreased to 3 cm. There were no surgical complications in both cases. Conclusions Staging surgery for complicated pediatric congenital scoliosis surgery is more practical, lower risk, and better outcome.