后路半椎体切除治疗先天性半椎体畸形

Hemivertebra resection for the treatment of congenital scoliosis with posterior approach

目的：评估后路外科矫治先天性半椎体畸形的临床疗效,探讨后路手术矫治先天性半椎体畸形的策略、技术要点及应用价值。方法回顾性分析2009年1月-2013年12月采用单纯后路手术矫治的先天性半椎体脊柱畸形65例患者的临床资料,其中男28例、女37例,平均年龄9.5岁（2~43岁）,均行后路半椎体切除椎弓根螺钉内固定,实施矫形和脊柱平衡重建。比较术前、术后、末次随访Cobb角、顶椎偏移、躯干偏移等指标。结果65例手术均顺利完成,无手术死亡或围术期死亡病例。术后随访14~50个月,平均27个月。侧凸Cobb角由术前35.9°±6.0°,纠正至术后6.0°±1.6°,末次随访5.3°±1.5°,矫正率85.2%；后凸Cobb角同正常值的差距术前28.5°±9.3°,术后6.6°±1.4°,末次随访5.9°±1.4°,矫正率平均79.3%；术前顶椎偏移（31.4±6.3） mm,术后（6.2±1.4） mm,末次随访（5.7±1.5） mm；术前躯干偏移（17.8±2.1） mm,术后（5.5±1.3） mm,末次随访（4.6±1.0） mm；各观察项目术前、术后比较,差异均有统计学意义（P值均〈0.01）。术后无感染、神经损伤等并发症发生,无假关节形成。1例发生椎弓根螺钉松动、移位。2例术前下肢不完全性瘫痪患者神经功能末次随访时已恢复正常,Frankel评级E级。结论后路半椎体切除矫治先天性脊柱畸形可直接去除致畸因素,手术时间短、创伤小、融合节段少,并可有效重建脊柱冠状面及矢状面平衡。

Objective To evalue the results of hemivertebra resection of congenital scolisosis through posterior approach. Methods From January 2009 to December 2013, 65 patients with congeital scoliosis were retrospectively investigated. There were 28 males and 37 females with an average age of 9. 5 years（ range, 2 -43 years ） . They were managed by resection of the hemivertebra through a posterior approach. The chang of Cobb′s angle of scoliosis, apart from the apical vertebral translation and the trunk shift were compared in preoperation, postoperation and the last follow-up. Results All the cases were followed up（range, 14-50 months）. The mean Cobb′s angle of scoliosis were corrected from 35. 9° ± 6. 0° preoperatively to 6. 0° ± 1. 6° postoperatively and to 5. 3° ± 1. 5° in the follow-up period with a correction rate of 85. 2%, and the Cobb′s angle of kyphosis was improved from 28. 5° ± 9. 3° to 6. 6° ± 1. 4° after the operation. Apart from the apical vertebral translation improved from（31. 4 ± 6.3）mm preoperatively to （6. 2 ± 1. 4）mm postoperatively, the average trunk shift was also corrected from preoperative （17. 8 ± 2. 1） mm to postoperative （5. 5 ± 1. 3）mm. No complications were observed except 1 case of screw loosening. In addition, 2 cases with incomplete paraplegia were recovered gradually. Conclusions Hemivertebra resection through posterior approach to manage congenital scoliosis can eliminate the deformity, shorten the operation time, reduce fusion segments and rebalance the spine.