儿童颈椎后凸畸形治疗的挑战和经验:一项16例患者的单中心回顾性总结  

Challenges and experiences of managing cervical kyphosis in children:a single-centre retrospective summary of 16 cases

作　　者：张瀚文 姚子明 郭东[1] 刘昊楠 李承鑫[1] 张学军[1] Zhang Hanwen;Yao Ziming;Guo Dong;Liu Haonan;Li Chengxin;Zhang Xuejun(Department of Orthopedics,Affiliated Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京儿童医院骨科,北京100045

出　　处：《临床小儿外科杂志》2023年第11期1021-1028,共8页Journal of Clinical Pediatric Surgery

基　　金：中央高水平医院临床科研业务费资助(2022-PUMCH-D-004)

摘　　要：目的总结儿童颈椎后凸畸形的临床特点和手术疗效,提高诊疗效果。方法回顾性分析2013年1月至2023年1月于首都医科大学附属北京儿童医院骨科接受手术治疗的儿童颈椎后凸畸形患者临床资料,总结致畸原因、影像学特征、手术方法、疗效和预后。根据临床资料收集时间,将所有患儿术前、术后和末次随访时颈椎后凸角、后凸矫正率和美国脊髓损伤学会分级进行分组对比。结果本研究共纳入颈椎后凸畸形患儿16例,男7例、女9例;年龄(8.2±4.7)岁。致畸原因:先天性9例、Ⅰ型神经纤维瘤病3例、结核性2例、医源性1例和外伤性1例。16例颈椎后凸畸形患儿均顺利完成手术,术中无一例血管神经和周围脏器损伤,围手术期无一例严重并发症。9例行单纯前路手术,主要术式为前路颈椎椎间盘切除减压植骨融合术/前路颈椎椎体次全切除植骨融合术+前路序贯椎间扩张矫形术;6例行前后路联合手术(其中1例采用分期手术);1例行单纯后路手术(半椎体切除+椎弓根钉棒固定融合)。术前颈椎后凸角为47.0°(43.0,55.5)°,术后颈椎后凸角为6.5°(0,15.8)°,末次随访时颈椎后凸角为9.5°(6.5,13.3)°,术后和末次随访时的颈椎后凸角均较术前明显改善(Z=-4.836,P<0.001;Z=-4.829,P<0.001),但术后和末次随访时的颈椎后凸角差异无统计学意义(Z=-1.593,P=0.111)。术后随访3个月,患儿均内固定在位且术区骨性融合;随访期间,6例出现远端交界性后凸,3例出现临近节段退变。末次随访时所有患儿美国脊髓损伤学会分级评级均为E级,较术前明显好转(Z=14.545,P<0.001)。结论儿童颈椎后凸畸形临床罕见,根据病因和局部畸形情况个体化设计治疗方案可取得较好预后,但需警惕远期邻近节段退变和远端交界性后凸等问题。Objective To explore the clinical characteristics and surgical efficacies of children with cervical kyphosis(CK)and improve its therapeutic efficiency.Methods The relevant clinical data were retrospectively reviewed for 16 CK children operated from January 2013 to January 2023.The causes of deformity,imaging characteristics,surgical approaches and outcomes were summarized.Results There were 7 boys and 9 girls with a mean age of(8.2±4.7)(11/12-15.75)year.The underlying causes were congenital(n=9),NF-1(n=3),tuberculosis(n=2),medical(n=1)and traumatic(n=1).All procedures were successfully completed without no serious perioperative complications.The procedures included simple anterior surgery of ACDF/ACCF+ASDI(n=9),combined 1-stage anterio-posterior surgery(n=6)and simple posterior hemilaminectomy plus pedicle fixation&fusion(n=1).Mean preoperative CK was 47.0(43.0±55.5)°,mean postoperative kyphosis 6.5(0,15.8)°and mean kyphosis 9.5(6.5,13.3)°at the last follow-up.During 3-month follow-ups,bony fusion was achieved after internal fixation in operative area.Postoperative and final follow-up posterior convexity was significantly better than preoperative(Z=-4.836,P<0.001;Z=-4.829,P<0.001)and there was no significant loss of correction(Z=-1.593,P=0.111).During follow-ups,there were distal junctional kyphosis(DJK,n=6)and adjacent segment disease(ASD,n=3).All of them attained ASIA grade E at the final follow-up.Conclusions CK in children is a rare clinical entity with decent outcomes when treatment is individualized according to its cause and local deformity.However,cautions should be taken against the development of ASD and DJK.

关 键 词：脊柱后凸 先天畸形 外科手术 儿童 

分 类 号：R726.8[医药卫生—儿科]