后路半椎体切除短节段固定治疗6岁以下儿童先天性脊柱侧后凸

Posterior hemivertebra resection and short-segment fixation for treatment of congenital kyphoscoliosis deformity in children under 6 years of age

[目的]观察6岁以下儿童后路半椎体切除短节段固定的安全性及疗效。[方法]回顾性分析2009年2月-2014年12月接受后路半椎体切除短节段固定的脊柱侧后凸患儿31例。其中男15例,女16例;年龄1岁11个月-5岁5个月,平均3岁9个月。记录手术时间,术中出血量,术前、术后及末次随访影像学的改变。通过文献复习,从而评价手术效果及安全性。[结果]手术时间133-288 min,平均手术时间157 min。出血量50-600 ml,平均324.5 ml。术后2周冠状面及矢状面主弯Cobb角分别为2°-25°及13°-20°,平均矫形率分别为67.8%、50.1%,与术前比较差异具有统计学意义（P〈0.05）。术后所有病例均获得随访,随访时间11-48个月,平均23个月。末次随访冠状面及矢状面主弯Cobb角,与术后2周比较差异无统计学意义（P〉0.05）。所有患者随访期间恢复良好,无其他神经系统并发症及感染,内固定无断钉及松动,矫正度无显著丢失。[结论]先天性脊柱侧后凸采用后路半椎体切除是控制畸形进展的有效方式。尽可能早地选择手术,可获得冠状面和矢状面良好的矫正效果、低神经损伤风险,可避免手术节段延长。

[Objective] To observe the safety and efficacy of posterior hemivertebra resection and short- segment fixation in children under 6 years of age. [Methods] Thirty- one consecutive cases of congenital kyphoscoliosis treated by posterior approach hemivertebra resection and short segement fixation from February 2009 to December 2014 were investigated retrospectively. Patients included 15 males and 16 females,aged from 23 months to 65 months（ mean,45 months）. The time of operations and intraoperative blood loss,the change of radiological imagings at pre- operation,post- operation and last follow- up were recorded. Literature was also reviewed,in order to evaluate the effect and safety of operation. [Results] The operation time was 133 - 288 min（ mean,157 min） and blood loss was 50 - 600 ml（ mean,324. 5 ml）. We measured and recorded the data of the average correction of post- operative coronal main curve Cobb angel,kyphosis main curve Cobb angel. Patients were followed up for 11 to 48 months（ mean,23 months）. Two weeks after the operation,the correction rates were 55. 4%,53. 9%（ P〈0. 05） respectively. Compared with the results recorded two weeks after the operations,the result at last follow- up showed no significant difference（ P〈0. 05）. During the follow- up period,all cases showed good recovery without major complications（ such as neurological impairment,infection,instrumentation mobilization or failure,effects of correction lost）. [Conclusion] Posterior hemivertebra resection is an effective procedure,which can control the development progress of congenital kyphoscoliosis. Surgery should be done as soon as possible so as to avoid the use of long segment arthrodesis,bring low neurological impairment risk and achieve excellent frontal and sagittal correction.