后路半椎体全切钉棒固定治疗幼儿先天性脊柱侧凸畸形  

Posterior hemivertebra resection and internal fixation in the treatment of congenital scoliosis of infant

作　　者：何宗儒 刘杰[2] 郭士方[2] 钱耀文[2] 

机构地区：[1]宁夏医科大学研究生院,宁夏银川750000 [2]甘肃省人民医院骨科,甘肃兰州730000

出　　处：《临床骨科杂志》2015年第3期288-291,共4页Journal of Clinical Orthopaedics

基　　金：甘肃卫生行业科研计划项目(编号:GSWST2010-15)

摘　　要：目的评价后路半椎体切除钉棒固定治疗幼儿先天性脊柱侧后凸畸形的临床效果。方法采用后路一期半椎体切除、椎弓根螺钉固定治疗16例完全性半椎体畸形患儿,手术时年龄12~27（15.56±3.79）个月。术前侧凸Cobb角为32°~45°（38.35°±3.44°）,Bending位侧凸26°~72°（53.26°±7.28°）。结果手术时间145~210（185±25）min,术中出血量220~580（375±58）ml,输血量300~480（450±38）ml;固定节段4~6（5.12±0.75）个椎体。患儿均获随访,时间13~26（18.5±3.2）个月。术后患儿站立位全脊柱正、侧位X线片示侧凸Cobb角9°~15°（12.26°±2.06°）,平均矫正率68.4%;末次随访时侧凸Cobb角12°~20°（17°±1.56°）,丢失约5°,平均矫正率55.3%。术后伤口愈合不良1例,无神经系统并发症。结论采用一期后路半椎体切除、钉棒固定治疗幼儿先天性脊柱侧凸畸形,可直接去除致畸因素,在幼儿可获得良好的临床效果。Objective To evaluate the surgical results of posterior hemivertebra resection and internal fixation with pedical screw in the treatment of congenital scoliosis caused by fully segmented hemivertebra of infant. Methods Posterior hemivertebra resection and internal fixation with pedical screw were used in the treatment of congenital scoliosis caused by fully segmented hemivertebra of infant children in 16 cases. Surgery age was 12 ~ 27（ 15. 56 ± 3. 79）months. Preoperative Cobb angle of 32° ~ 45°（ 38. 35° ± 3. 44°）; Bending bit scoliosis could be corrected to26° ~ 72°（ 53. 26° ± 7. 28°）. Results In 16 patients,the operation time was 145 ~ 210（ 185 ± 25） min,the blood loss was 220 ~ 580（ 375 ± 58） ml and blood transfusion during operation was 300 ~ 480（ 450 ± 38） ml,the fusion level was 4 ~ 6（ 5. 12 ± 0. 75） segments. Children were followed up for 13 ~ 26（ 18. 5 ± 3. 2） months. Postoperative standing whole spine lateral X-ray film showed scoliosis was corrected from 9° ~ 15°（ 12. 26° ± 2. 06°）,with a average correction rate of 68. 4%. Cobb angle at final follow-up was 12° ~ 20°（ 17° ± 1. 56°）,lost 5 °,the average correction rate was 55. 3%. One got delayed wound healing. There was no neurological complication. Conclusions Posterior hemivertebra resection and internal fixation with pedicle screw is effective in the treatment of congenital scoliosis caused by fully segmented hemivertebra of infant. Direct removal of teratogenic factors provide good results.

关 键 词：脊柱侧凸/先天性 半椎体 椎体切除 钉棒固定 幼儿 

分 类 号：R682.13[医药卫生—骨科学] R726.8[医药卫生—外科学]