后路半椎体切除矫治先天性脊柱侧后凸的疗效分析

Evaluation of Outcomes of Posterior Hemivertebra Resection in The Treatment of Congenital kyphoscoliosis with Hemivertebra

目的通过对本院经后路一期半椎体切除矫治先天性脊柱侧后凸畸形患者的分析,探讨术后近远期矫形效果。方法 2008-2013年我院共对先天性脊柱半椎体畸形患者经后路半椎体切除植骨融合内固定术35例,男22例,女13例;年龄5-48岁,平均17.06岁。术前、术后即刻和随访时均拍摄脊柱正侧位X线片,并测量半椎体所致侧、后凸Cobb角等评估指标,分别计算它们的改善率,记录围手术期及远期并发症。结果手术时间1.75-5.83 h,平均3.68 h。术中出血量60-2 000 mL,平均767.78 mL。全部病例随访13-60个月,平均35.8个月。手术前、后及末次随访侧凸Cobb角分别为（44.41±18.49）°、（13.07±9.11）°、（15.54±8.94）°,术后即刻矫正率为（71.32±16.94）%,最终矫正率（64.35±19.53）%。手术前、后及末次随访后凸Cobb角分别为（34.58±26.18）°、（10.36±11.94）°、（11.94±11.81）°,术后即刻矫正率（67.91±21.89）%,最终矫正率（58.56±30.88）%。头侧出现新的后凸畸形1例,植骨不融合1例,通过二次手术,延长固定节段,畸形得到明显矫正。末次随访时均无椎弓根切割、神经系统并发症发生,无切口愈合不良、钉棒断裂及假关节形成等。结论对于先天性脊柱半椎体侧后凸畸形患者,采用一期经后路半椎体切除安全有效,具有手术时间短、出血量少、对脏器损伤小、并发症发生率低等优点。

Objective To evaluate the outcomes of surgical treatment for congenital spinal deformity.Methods From2008 to 2013,there were 35 consecutive cases with congenital scoliosis were managed surgically with one-stage posterior hemivertebra resection and segmental instrumentation fixation and fusion.There were 22 males and 13 females,with the average age of 17.06 years（5 to 48 years）.Long cassette standing radiographs were taken before and after surgery and at the final followup.Scoliosis,kyphosis and other indexes were measured preoperatively and immediatly postoperatively as well as at the latest follow-up.We calculated the improvement rate separately,and recorded the perioperative and long-term complications.Results The average operative time was 3.68 hours with a mean 767.78 mL of blood loss.The average follow-up was 26.8 months ranging from 5 to 58 months.The scoliosis was（44.41 ± 18.49） ° before surgery,（13.07 ± 9.11） ° after surgery,and（15.54± 8.94） ° at latest follow-up.The kyphosis was（34.58 ± 26.18） ° before surgery and（10.36 ± 11.94） ° after surgery and（11.94 ±11.81） ° at latest follow-up.Apical vertebral translation,cranial and caudal compensatory curve and other indexes were improved.There was new kyphosis in 1 case,bone graft unfusion in 1 case.In through the second operation,we extended the fixed section,dramatically corrected deformity.There were no major complications and no neurologic damage.Conclusion Posterior hemivertebra resection and internal fixation is a safe and reasonable surgical option for congenital and kyphosis deformity.