一期前后联合入路截骨矫形治疗先天性颈椎侧凸

One stage circumferential osteotomy by combined approach in the treatment of congenital cervical scoliosis

目的：探讨一期前后路联合入路半椎体切除、环形截骨矫形术治疗先天性颈椎侧凸畸形的可行性、安全性，评价其初步疗效。方法：2009年12月～2013年11月应用一期前后路联合入路半椎骨切除、环形截骨矫形术治疗13例颈椎半椎体畸形导致的先天性颈椎侧凸患者，回顾性分析患者的资料，观察临床效果。统计神经根、脊髓、椎动脉、硬膜囊损伤等严重并发症。对比分析术前和术后颈椎CT冠状面重建图像上颈椎侧凸结构曲线和颈椎或者上胸椎的代偿曲线（Cobb角）。结果：13例患者中男8例，女5例。年龄5～15岁（9．2±3．4岁）。11例接受一期前路截骨、后路截骨矫形内固定融合、前路内固定融合术；2例接受一期前路截骨、后路截骨矫形内固定融合术，术后Halovest支具固定3个月。手术时间210．520min（324±92min），m血量150～1000ml（585±319m1）。5例术后出现凸侧神经根刺激症状，4例在术后6个月时完全缓解，1例在术后24个月时肱三头肌肌力仍为3级。随访24—60个月（30．0±12．4个月），颈椎侧凸结构曲线Cobb角由术前9°-45°（28．3°±11．0°）矫正至0°～25°（6．9°±7．8°），矫正率为44．4％～100％[（78±24）％]；颈椎或者上胸椎的代偿曲线Cobb角由术前0°-25°，（21．8°±5．8°）矫正至3°-23°（5．5°±4．3°），矫正率为8％～75％[（37±33）％]。末次随访时，患者头颈肩部外观显著改善。结论：采用一期前后路联合入路半椎体切除、环形截骨矫形术治疗先天性颈椎侧凸具有较好的可行性和安全性，初步临床及影像学效果满意。

Objectives： To apply one stage circumferential osteotomy to treat the congenital cervical seoliosis （also called as osteogenie torticollis）, and to evaluate the feasibility, safety and early clinical outcomes. Methods： Thirteen cases of congenital cervical scoliosis with hemivertebra deformity who received surgical correction were retrospectively reviewed. The clinical outcomes were evaluated. The severe complications such as injury of nerve root, spinal cord, vertebral artery and dural sac were collected and recorded. The Cobb angles of structural curve and compensatory curve were recorded and compared on coronal plane reconstruction im- ages in CT scan. Results： 13 patients with an average age of 9.2±3.4 years old（5-15） were treated. There were 8 males and 5 females. Two cases had anterior-posterior osteotomy with Halo-vest immobilization for three months. 11 eases had anterior-posterior-anterior osteotomy with soft collar for 6 weeks. The average op- eration time was 324±92mins with an average blood loss of 585±319ml. Five cases had convex side nerve root symptoms postoperatively. Four cases fully recovered at 6 months： after the operation. One case remained triceps power reduction（grade 3） at 24 months after the operation. No other complication was oecured. The av- erage follow-up period was 30.0±12.4 months（24-60 months）. The Cobb angle of structural curve was 28.3°± 11.0°（9°-45°） preoperatively and 6.90±7.80（0°-25°） postoperatively. The correction ratio was （78±24）%. The Cobb angle of compensatory curve was 21.8°±5.8°（0°-25°） preoperatively and 5.5°±4.3°（3°-23°） postoperatively. The correction ratio was （37±33）%. The patient＇s appearance improved significantly after the surgery. Condo- sions： The one stage circumferential osteotomy for the treatment of congenital cervical scoliosis is feasible and safe. The clinical and radiological outcomes are satisfactory.