应用凸侧融合凹侧撑开方法治疗半椎体所致先天性脊柱侧凸

The long-term results of the combined anterior and posterior convex fusion with the concave subcutaneous distraction of the treatment of congenital scoliosis due to fully segmental hemivertebra

目的评价应用前后路凸侧融合及凹侧皮下撑开治疗下胸椎完全分节型半椎体所致先天性脊柱侧凸的远期疗效。方法6例半椎体所致先天性脊柱侧凸患儿,男5例,女1例;年龄为4个月～2.6岁,平均11个月;手术时年龄1.6～5.9岁,平均3.4岁。均行全脊柱正侧位X线检查,采用Cobb法测量手术前后及随访时脊柱后凸角及侧凸角,了解冠状面及矢状面畸形矫正情况。结果6例患儿,经7.7～11.9年(平均10年10个月)随访,冠状面侧凸畸形由术前的49°改善至29°,改善率为41%;矢状面畸形改善程度不尽相同,3例后凸畸形有所改善,1例无明显变化,2例加重。结论前后路凸侧融合及凹侧皮下撑开手术,是治疗T11或T12半椎体引起的先天性脊柱侧凸的有效方法。

Objective To evaluate the long term results of combined anterior and posterior convex fusion with the concave subcutaneous distraction instrumentation for the treatment of congenital scoliosis due to fully segmental hemivertebra at T11 or T12. Methods The study covered six patients(5 male, 1 female) with the average postoperative follow up of 10 years and 10 months(range 7.7-11.9 years). The type of vertebral anomaly was limited to fully segmental hemivertebra and the site was concentrated in T11 or T12. All patients underwent the one stage anterior and posterior convex epiphysiodesis at early ages(average 3.4 years, range 1.6-5.9 years). The subcutaneous instrumentation were placed by the posterior approach, permitting correction of scoliosis by intermittent distraction(average 2.2 times, range 1-4 times). Three patients were skeletally mature at final follow up, and the mean age of other three was 13.2 years. Clinical assessment and sequential measurement of Cobb angle in the coronal and sagittal plane were carried out by the same person. Results All the coronal curves were improved. The mean Cobb angle in the coronal plane was 49° pre operatively and 29° at final follow up, representing a 41% improvement. In the sagittal plane, the outcome was not as satisfactory and varied between patients. The mean Cobb angle showed no change with 28° preoperatively to 29° at follow up, kyphosis improved in 3 cases, deteriorated in 2 cases and remained unchanged in one case. Two complications occurred. One experienced delayed infection which was cured by removal of hardware and antibiotics, one presented a curve progression due to pseudarthrosis. Conlusion The combined anterior and posterior fusion with subcutaneous concave distraction is an effective method for the treatment of congenital scoliosis resulting from fully segmented hemivertebra of T11 or T12 at an earlier age of less than 6 years.