不同术式早期治疗半椎体型先天性脊柱侧弯的临床疗效比较  

The treatment of scoliosis of hemivertebrae under 5 years old and comparation of two different surgical methods

作　　者：杨红军[1] 杨建平[1] 曾裴[1] 龚仁钰[1] 蔡少华[1] 

机构地区：[1]天津医院小儿骨科,300211

出　　处：《临床小儿外科杂志》2007年第1期26-28,共3页Journal of Clinical Pediatric Surgery

摘　　要：目的比较前后路半椎体切除、后路短节段内固定术与单纯前后路凸侧骺阻滞术早期治疗半椎体型先天性脊柱侧弯的疗效。方法选择2000年9月～2005年6月收治的5岁以下完全分节半椎体型先天性脊柱侧弯患儿17例,男11例,女6例,平均年龄3岁2个月,均为T10～L4半椎体畸形,根据术式将17例患儿分为A、B两组,A组10例,采取前后路半椎体切除、后路短节段内固定术,B组7例,采用单纯凸侧前后路骺阻滞术。结果A组平均年龄3岁1个月,术前侧弯平均Cobb角为44°,术后平均随访时间3年3个月,随访时平均Cobb角为17°,平均矫正率为61.4%;B组平均年龄2岁11个月,术前侧弯平均Cobb角为46°,术后平均随访时间3年5个月,随访时平均Cobb角为21°,平均矫正率为54.4%。两组伴后凸畸形者术后无加重。两组侧弯矫形效果比较,差异无统计学意义(P=0.107)。结论两种术式在治疗5岁以下一定弧度内的半椎体型先天性脊柱畸形方面,均可达到限制畸形进展或矫形的目的,但凸侧骨骺阻滞术无需切除半椎体和内固定器械矫形,具有手术时间短、术中出血少、相对安全、治疗费用低的优点。Objective To discuss the indication and effect of two different surgical methods in the treatment of hemivertebral scoliosis. Methods From the Sep in 2000 to Jun in 2005,a consecutive series of 17 congenital scoliosis or kyphoscoliosis under 5 years old due to hemivertebrae were managed by two kinds of surgical methods, of them, eleven males and six females, the mean age at surgery was 38 months （from 13 to 59 months）. All deformities were due to hemivertebrae from T10 to L4. 10 cases （A group） was treated by hemivertebrae resection using a posterior combined with anterior approach and short posterior internal fixation in the same day/same anesthesia. 7 （B group） was managed by convex epiphysiodesis using a posterior combined with anterior approach. Results The mean age of A group at surgery was 37 months. The mean follow-up period was 39 months.There was a mean orthotic rate of 61.4% in the segmental curve from was a mean angle of 44 degrees before surgery to 17 degrees at the later on follow-up assessment. The mean age of B group at surgery was 35 months. The mean follow-up period was 41 months. The curve from a mean angle of 46 degrees before surgery to 21 degrees at the latest follow-up assessment,and the mean orthotic rate was 54.4%.The result of this two groups was no statistical difference （P=- 0.107）,Kyphosis of this two groups were all stabilized or improved at the later on follow-up assessment. Conclusions Convex growth arrest is a safe and effective method in the management of patients,who is younger than age 5 years old whose Cobb＇ s angle below 50 degrees.

关 键 词：脊件侧凸/外科学 

分 类 号：R726.8[医药卫生—儿科]