后路半椎体切除短节段内固定融合治疗青少年完全分节型半椎体脊柱畸形  

Single-stage excision of hemivertebrae via the posterior approach along with short segment internal fixation for congenital kyphoscoliosis of fully segmented hemivertebrae

作　　者：张宏其[1] 刘少华[1] 郭超峰[1] 陈凌强[1] 付美奇[1] 陈小明[1] 王永福[1] 陈静[1] 

机构地区：[1]中南大学湘雅医院脊柱外科湘雅脊柱外科中心,长沙市410008

出　　处：《中国脊柱脊髓杂志》2008年第7期517-521,共5页Chinese Journal of Spine and Spinal Cord

基　　金：湖南省卫生厅科研基金资助项目(项目编号:B2006-040);湖南省科技厅科技计划一般项目(项目编号:06SK3015)

摘　　要：目的:探讨一期后路半椎体切除、短节段内固定融合治疗青少年完全分节型半椎体所致先天性脊柱侧后凸畸形的临床疗效。方法:2002年3月～2005年12月,对19例完全分节型半椎体所致先天性脊柱侧后凸患者行一期后路半椎体切除、短节段内固定融合术,年龄9岁8个月～19岁4个月,平均13岁9个月,术后随访1年7个月～5年4个月,平均3年2个月。通过术前、术后及随访时站立位脊柱正位和侧位X线片测量,评价冠状面及矢状面的矫形效果。结果:术中发生螺钉切割椎弓根1例,延长1个节段行内固定。所有患者躯干平衡良好,均无感染及神经系统并发症发生。节段侧凸角术前平均37.7°,术后2周时平均8.2°,矫正率78.2%,总侧凸角术前平均40.7°,术后2周时平均10.3°,矫正率为74.7%,后凸角术前平均25.2°,术后2周时平均6.5°,矫正率为74.2%,末次随访时侧凸及后凸矫形均无明显丢失。结论:采用一期后路半椎体切除、短节段内固定融合治疗完全分节型半椎体所致的先天性脊柱侧凸融合节段少,可获得良好的矫形效果。Objective：To evaluate the effect of single-stage excision of hemivertebrae via the posterior approach along with short segment internal fixation for adolescent congenital kyphoscoliosis caused by fully segmented hemivertebrae.Method：From March 2002 to December 2005,a consecutive series of 19 adolescent congenital kyphoscoliosis due to fully segmented hemivertebrae were managed by posterior approach along with short segment internal fixation.The mean age at time of surgery was 13 years and 9 months （range,from 9 years and 8 months to 19 years and 4 months ）.The average time of follow-up was 3 years and 2 months （range,from 1 year and 7 months to 5 years and 4 months）.The coronal and the sagittal angles were analyzed to determine the corrective effect of kyphoscoliosis by measuring the data from the standing anteriorposterior and lateral plain films,which were taken before and after the operation,and at the follow-up respectively.Result：There was a mean improvement of 78.2% for the segmental curve from a mean angle of 37.7° before surgery to 8.2° two weeks after surgery.The mean Cobb angle of the main curve was 40.7° before surgery,10.3° two weeks after surgery,the correction rate of the main curve was 74.7%.The correction rate for kyphosis was 74.2%,improved from 25.2° to 6.5° on the average.At the last follow-up,no significant loss of scoliotic and kyphotic correction occured.Trunk shift was improved noticeably.There was no infection and neurological deficits,but one pedicle fracture.Conclusion：Single-stage excision of hemivertebrae via the posterior approach along with short segment internal fixation has a good effectiveness in the adolescent congenital kyphoscoliosis caused by fully segmented hemivertebrae.lt provides short segmental fusion,more reliable reconstruction of the spinal column without significant complications.By this procedure the hemivertebrae can be removed directly,thereafter an excellent correction in both coronal and sagittal planes can be achieved.

关 键 词：先天性脊柱侧后凸 半椎体 短节段 内固定 

分 类 号：R682.1[医药卫生—骨科学]