儿童腰骶部半椎体早期后路切除治疗

Early posterior lumbosacral hemivertebra resection in children

目的探讨儿童腰骶部半椎体的治疗方法及临床疗效。方法回顾性分析2000年10月至2014年7月我院诊治的18例腰骶部半椎体的患儿的临床资料。通过对其手术前后影像学检查、查体及病历资料分析，评估其发病特点、手术方式、手术前后及末次随访时侧弯后凸Cobb角变化和躯干偏移改善情况。结果本研究18例患儿手术时平均年龄5．1岁，8例患儿合并其他部位1～3个半椎体，14例合并脊髓拴系综合征等脊髓畸形。所有患儿均行一期经后路切除半椎体，4例无内固定，14例椎弓根螺钉内固定，术后平均随访63个月。术前半椎体节段Cobb角平均25．9°，术后平均11．3°，末次随访时平均10．4°，术后平均即刻矫正率为56．4％，末次随访时平均侧弯矫正率为59．8％。手术前近端代偿弯Cobb角平均20．8°，术后平均12．6°，末次随访平均12．0°，术后平均即刻矫正率为40．O％，末次随访时平均为43．3％。矢状面无后凸畸形，躯干偏移较前改善。术后1例因凸侧髂骨钉断钉导致侧弯矫正失败，2例术后出现短暂神经功能障碍，随访时1例较前好转，1例完全恢复，其余无椎弓根钉切割、断钉棒、感染、神经损伤等并发症。结论儿童腰骶部半椎体容易合并脊髓畸形，早期行脊髓畸形手术同时可以后路切除半椎体不用内固定。早期后路腰骶部半椎体切除使用内固定能有效治疗脊柱畸形，避免局部严重畸形和防止继发代偿畸形，避免出现长节段的固定融合。

Objective To evaluate the surgical procedures and outcomes of congenital scoliosis due to lumbosacral hemivertebra. Methods From October 2000 to July 2014, a consecutive series of 18 congenital scolioses due to lumbosacral hemivertebra were treated by hemivertebra resection using a single posterior approach and fusion with or without instrumentation. Through a retrospective review of clinical records with clinical and radiographic assessments, the anatomic data of hemivertebra, surgical approach, coronal and sagittal Cobb angle pre and post-operation and final follow-up, coronal trunk shift improvements. Results The average operation age was 5. I years, 8 children with other parts 1-3 hemivertebra, 14 cases combined with tethered cord syndrome or other spinal cord malformation. All patients underwent hemivertebral resection with posterior approach. The average follow-up period was 63 months. The average coronal Cobb angle of lumbosacral curve was 25.9 preoperation, 11.3 post-operation and 10. 4 at the final follow-up. This represents a average improvement of 56. 4° post-operation and 59. 8° at the final follow-up. The average coronal Cobb angle of proximal lumbar curve was 20. 8 pre-operation, 12. 6 post-operation and 12. 0 at the final follow-up. It represented a average improvement of 40. 0° and 43. 3% respectively. The average final lordosis was within normal range. Trunk shift had significant improvement. Only one case had failed treatment because of rod ruptures. Two children of nerve injury recovered. Others had no complication such as fractures of pedicle at the instrumented level, infection and nerve injury. Conclusions Lumbosacral hemivertebra of children is always associated with spinal cord malformation. Early operation of spinal cord malformation may excise hemivertebra at the same time without internal fixation. Early surgery of hemivertebra excision with internal fixation may savert severe local deformities and prevent compensatory curve structural changes deformities, avoid extensive fusions.