半椎体切除术治疗先天性脊柱侧凸

Surgical correction of congenital scoliosis caused by hemivertebra in children

为探讨单纯后路和前后路切除半椎体治疗先天性脊柱侧凸的疗效 ,回顾分析了19例先天性脊柱侧凸共21个半椎体的治疗。其中T7、T9、T11、L1、L4 各1例 ,T10、L2、L3 各2例 ,T1210例 ,均为完全分节型半椎体 ;单纯后路切除10例 ,前后路切除9例 ;术前Cobb角20°～95°,平均46°。随访10个月～28个月 ,平均19个月。结果术后冠状面平均矫正51 % ,平均矫正丢失6°;2例后凸畸形得到矫正 ,无神经并发症及假关节发生。提示单纯后路或前后路半椎体切除效果满意 ,其中单纯后路半椎体切除术主要用于胸椎。

To evaluate and verify the effectiveness of one_stage posterior hemivertebra resection and anteroposterior hemivertebra excision in the surgical treatment of congenital scoliosis in children,19 affected children treated in our department during the years 1999～2001 were retrospectively reviewed and analyzed.The average age of these cases during operation was 7 years old with a range of 16 months～12 years.These 19 patients had 21 deformed hemivertebra in total,all of which showed such a type of fully_segmental hemivertebra.The deformity location was discovered to be as follows:T7,T9,T11,L1 and L4 separately in one case;T10,L2 and L3 separately in two cases;and T12 in ten cases.Besides,the preoperative curve in coronal plane averaged 46 degrees,ranging from 20 to 95 degrees.Afterwards,one stage posterior hemivertebra resection was adopted for the correction of the deformity in 10 cases and anteroposterior hemivertebra excision was also chosen in 9 cases.Posterior instrumentation was well used for the correction of the deformity in all of the patients.Then,a longer follow_up observation was carried out to identify the clinial effectiveness of the surgical correction in an average interval of 19 months with a range of 10～28 months.According to the analysis of clinical records,the average correction rate of the curve in coronal plane could get access to nearly 51% in immediate postoperative period.Meanwhile,the average correction loss of the curve in coronal plane during follow_up was found to be only approximately 6 degrees.Significantly,no neurological complications occurred and pseudoarthrosis developed in none of the patients.Moreover,the sagittal contour was considerably improved in 2 cases with kyphoscoliotic deformity.Thus,it is concluded that a good effectiveness of one_stage posterior hemivertebra resection and anteroposterior hemivertebra excision could be satisfactorily obtained in the surgical correction of congenital scoliosis and especially the one_stage posterior hemivertebra resection should be best indicated for single thoracic or thoracolumbar deformity in chlidren.