后路半椎体切除术治疗婴幼儿先天性脊柱侧凸的疗效及其并发症

Efficacy and complication of posterior hemivertebra resection in infants with congenital scoliosis

目的：评估后路半椎体切除术治疗婴幼儿先天性脊柱侧凸的临床效果及其并发症。方法：回顾性分析2003年1月~2012年1月在我院接受手术治疗的半椎体所致婴幼儿先天性脊柱侧凸患者39例（男21例,女18例）,年龄3.5±1.1岁（2~5岁）,其中3例合并心脏畸形,1例合并脊髓拴系,1例合并脊髓空洞。均采用后路半椎体切除、椎弓根螺钉固定及植骨融合术。总结患者临床资料及术前、术后及末次随访时全脊柱正侧位X线片,并记录手术并发症及矫形效果。结果：手术时间189.9±56.8min,出血量306.6±152.3ml。手术切除单个半椎体35例,切除2个半椎体4例。融合节段数3.4±1.4个,其中2节段融合22例,占56.4%。术后随访时间5.9±2.6年（3~11年）。术前冠状面节段性侧凸Cobb角39.3°±12.2°,术后即刻6.3°±7.2°,矫正率为（85.2±14.8）%,末次随访丢失3.2°±7.7°;术前节段性后凸角17.7°±17.0°,术后即刻2.9°±8.2°,矫形率为（87.0±69.0）%,末次随访丢失3.2°±11.4°;术后冠状面矫形节段头侧代偿弯及尾侧代偿弯自发矫正率（72.0±46.4）%和（81.8±34.5）%。手术前后比较有统计学差异（P〈0.05）。围手术期及随访过程中发生了3例并发症（7.7%）,包括椎弓根骨折1例,断棒1例,畸形加重行翻修1例。另有2例患者随访过程中发现椎弓根拉长。所有患者均未出现神经系统并发症。结论：后路半椎体切除术对婴幼儿先天性脊柱侧凸患者是一种安全有效的手术方式。早期手术可以达到短节段固定融合,但是内固定及与脊柱生长相关的并发症仍需临床医师重视。

Objectives： To evaluate the complication and efficacy of posterior hemivertebra resection with transpedicular instrumentation in infants with congenital scoliosis. Methods： From January 2003 to January2012, 39 consecutive cases of congenital scoliosis due to hemivertebra were retrospectively investigated in our hospital, including 18 females and 21 males, aged from 2 to 5 years（average 3.4 years）. Three cases were combined with congenital cardiac malformation, one case had previous spinal cord untethering procedure, and one case was combined with syringomyelia. All the patients underwent posterior hemivertebra resection with pedicle screw fixation. The medical records were reviewed and long cassette spinal radiographs of spine were measured at preoperation, postoperation and final follow-up to record the corrections and complications. Results： The mean operation time was 189.9±56.8min with an average blood loss of 306.6±152.3ml. The total number of resected hemivertebrae was 43, including 35 cases with one hemivertebra and 4 cases with two.The average fused segments were 3.4 ±1.4, including monosegmental fusion of two adjacent vertebrae in 22cases（56.4%）. The average follow-up was 5.9±2.6 years. The segmental coronal Cobb′s angle was corrected from 39.3°±12.2° before surgery to 6.3°±7.2° after surgery with a mean correction rate of（85.2 ±14.8）%, and the segmental kyphosis was corrected from 17.7°±17.0° to 2.9° ±8.2° with a mean correction rate of（87.0 ±69.0）% over the same time period. The spontaneous correction rate of the compensatory cranial curve and compensatory caudal curve was（72.0±46.4）% and（81.8±34.5）% respectively, the Cobb′s angles of the curves before surgery and after surgery was significant differences（P〈0.05）. Complications were found in 3 patients（7.6%）, including 1 pedicle fracture, 1 rod breakage, 1 curve progression. There was no neurological complication. Two cases needed implant removal because of pedicle elongation in the follow-up. Conclusions： Posterior hemivertebra resection is a safe and effective procedure in infants with congenital scoliosis. Short-segment fusion and saving more mobile segments are possible in the procedure. However, complications associated with implants and spinal growth still remain a challenge.