先天性脊柱侧凸的外科治疗

The surgical treatment of congenital scoliosis

目的 探讨先天性脊柱侧凸外科治疗的时机和方法。方法 1993年 2月至 2 0 0 0年 12月 ,共手术治疗先天性脊柱侧凸 16例 ,其中男 4例 ,女 12例 ,年龄 2 .5～ 15岁 ,平均 12 .5岁。其中先天性半椎体 8例 ,分节不良 5例 ,混合型 3例。术前Cobb’s角 35°～ 80° ,平均 6 0 .5°。治疗方法有Ⅰ期前后路半椎体切除并后路内固定脊柱融合术 8例 ,单纯后路内固定脊柱融合术 4例 ,分次后路撑开不融合 4例。结果 平均随访时间 3年 8个月 ,术后Cobb’s角 15°～ 4 0° ,平均 30 .2°,平均矫正率 5 0 .1%。并发症包括椎板、椎弓骨折 2例、脱钩 2例、假关节 1例。无神经系统并发症。

Objective To evaluate the surgical timing and procedure to the treatment of congenital scoliosis. Methods 16 cases of congenital scoliosis were operated between Feb. 1993 and Dec. 2000. Among them, there were 4 boys and 12 girls with an average age of 12.5 years (range: 2.5 ～15 years). There were 8 cases of congenital hemivertebra, 5 cases of failure of segmentation and 3 cases of mixed type. The pre operative Cobb angle was on average of 60.5° (range from 35～80°). The surgical procedures included one stage combined anterior release and posterior instrumentation with in situ spinal fusion in 8 cases, posterior instrumentation with in situ spinal fusion in 4 cases, intermittent distracting rod with no fusion in 4 cases. Results The post operation Cobb angle was on average of 30.2° (range from 15～40°) with a mean correction rate of 50.1% . The complications included 2 cases of intra operative laminar and/or pedicle fractures and 2 cases of dislodgement of the hooks and 1 case of pseudoarthrosis. There were no neurological sequelae in this series. Conclusions Early surgical intervention is the best treatment of congenital scoliosis. Different procedures are advised for children of different ages and different types of scoliosis.