单一后路半椎体选择性部分切除内固定术治疗先天性脊柱侧后凸畸形

TREATMENT OF CONGENITAL KYPHOSCOLIOSIS WITH SELECTIVE-PARTIAL HEMIVERTEBRA RESECTION AND INSTRUMENTATION VIA POSTERIOR APPROACH

目的 探讨单一后路半椎体选择性部分切除内固定术治疗先天性脊柱侧后凸畸形的疗效。方法 2008年1月-2011年8月,采用单一后路半椎体选择性部分切除内固定术治疗17例半椎体所致先天性脊柱侧后凸畸形患儿。男10例,女7例;年龄9～14岁,平均10.8岁。15例存在腰背部疼痛,3例合并轻度双下肢麻木等神经系统损害体征。Risser征0级3例,1级2例,2级7例,3级5例。均为完全分节型半椎体,半椎体节段：胸段9例、胸腰段4例、腰段4例。比较术前、术后10 d及末次随访时节段侧凸角、总侧凸角及节段后凸角,评估矫正效果及维持情况。结果 术中固定2～7个节段,平均3.7个节段。手术时间4～6 h,平均4.77 h。术中出血量300～1 100 mL,平均611.76 mL。术后切口均Ⅰ期愈合,均未出现感染或神经系统并发症。患儿均获随访,随访时间6～37个月,平均20.12个月。患儿背部疼痛及双下肢麻木等症状均消除。X线片检查示,植骨完全融合,融合时间6～18个月,平均12个月。术后10 d及末次随访时节段侧凸角、总侧凸角及节段后凸角均较术前显著减小（P〈0.05）;除节段后凸角外,末次随访时节段侧凸角及总侧凸角较术后10 d增大,比较差异有统计学意义（P〈0.05）。术后节段侧凸角、总侧凸角及节段后凸角矫形率分别为64.35%±0.07%、65.08%±0.07%、72.26%±0.11%,矫形丢失分别为（3.04±1.17）、（2.81±0.93）、（0.75±0.50）°。结论 对于9～14岁、Risser征0～3级、总侧凸角〈60°、由半椎体所致的先天性脊柱侧后凸畸形,通过单一后路半椎体选择性部分切除内固定术可切除多余生长中心,平衡脊柱两侧生长,获得较好疗效。

Objective To investigate the effectiveness of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis. Methods Between January 2008 and August 2011, 17 patients with congenital kyphoscoliosis were treated by selective-partial hemivertebra resection and instrumentation via posterior approach. There were 10 boys and 7 girls with the mean age of 10.8 years （range, 9-14 years）. Of them, 15 cases had lumbar back pain, and 3 cases had lower limb numbness of nervous system damage symptoms. Risser sign was rated as grade 0 in 3 cases, grade 1 in 2 cases, grade 2 in 7 cases, and grade 3 in 5 cases. The classification of deformity was fully segmental hemivertebra. The deformity located at the thoracic segment in 9 cases, at the thoracolumbar segment in 4 cases, and at the lumbar segment in 4 cases. The Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were measured at pre-operation, at 10 days after operation, and last follow-up to evaluate the correction effect. Results The 2-7 segments （mean, 3.7 segments） were fixed. The operation time was 4-6 hours （mean, 4.77 hours）. The intraoperative bleeding was 300-1 100 mL （mean, 611.76 mL）. All incisions healed by first intention, with no infection or complication of nervous system. All patients were followed up 6-37 months（mean, 20.12 months）. Back pain and numbness of lower limbs were eliminated. X-ray films showed complete bone graft fusion at 6-18 months （mean, 12 months）. At 10 days after operation and last follow-up, the Cobb angles of the main curves, segmental curves, and segmental kyphotic curves were significantly decreased compared with the preoperative angles （P〈0.05）; the Cobb angles of the main curves and segmental curves at last follow-up were significantly greater than those at 10 days after operation （P〈0.05） except the segmental kyphotic curves angle （P〉0.05）. Postoperative correction rates of the Cobb angles of the segmental curve, the main curves, and segmental kyphotic curves were 64.35%±0.07%, 65.08%±0.07%, and 72.26%±0.11%, respectively; loss of correction was （3.04±1.17）、（2.81±0.93）and（0.75±0.50）° respectively. Conclusion For patients at the age of 9-14 years, with the Risser sign between grade 0-3, and with the Cobb angles less than 60°, the selective-partial hemivertebra resection and instrumentation via posterior approach can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.