Ⅰ期后入路楔形切除术治疗低龄儿童半椎体畸形  

Resection of the hemivertebra from the back by the first stage in younger children

作　　者：宿玉玺[1] 谢艳 覃佳强[1] 南国新[1] 王忠良[1] 蔡文全[1] 张德文[1] 

机构地区：[1]重庆医科大学附属儿童医院骨科,干细胞实验室,儿童发育疾病研究教育部重点实验室儿科学重庆市重点实验室,重庆市400014 [2]重庆市渝北区妇幼保健院检验科,重庆市400010

出　　处：《临床小儿外科杂志》2015年第3期164-167,共4页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金项目(项目号:81001197);重庆市科委自然科学基金项目(项目号:CSTC,2010BB5109);国家临床重点专科建设项目资助(国卫办医函【2013】544)

摘　　要：目的：探讨 CD 三维矫形系统在矫正低龄儿童半椎体所致脊柱畸形中的应用方法、意义、并发症的处理及术后处理。方法2011年7月至2014年6月我们应用 CD 系统矫治低龄儿童半椎体所致脊柱侧后凸畸形27例，其中单纯性半椎体合并脊柱侧凸12例，半椎体合并脊柱侧、后凸15例。27例中，合并蝴蝶椎等复杂分节不良畸形6例，合并单侧肾脏缺如1例。术前冠状面侧凸 Cobb 角24°～45°，平均32°；矢状面脊柱后凸 Cobb 法0°～21°，平均15．5°，旋转畸形为Ⅰ～Ⅲ度。年龄1岁10个月至5岁8个月。手术均采用后路融合，固定点为需切除的病变椎上下椎体，若遇上下椎体有畸形不宜植钉，则适当上或下移一椎体。先固定凹侧，楔形切除半椎体附件及椎体，凸侧加压，钉棒系统固定。结果所有患儿术后经1～36个月（平均16个月）随访，冠状面畸形为5°～15°，平均11．5°，平均矫正率为64．1％；矢状面胸椎后凸0°～10°，平均6°，旋转畸形矫正。1例出现断钉1枚，但无症状及矫正丢失。无一例术后出现截瘫，无断棒及钉拔出等并发症。10例术后出现不同程度腹胀、腹痛现象，经对症处理后3～7 d 内明显缓解或消失。无一例出现伤口感染。15例术后出现10°以上代偿性侧弯，支具矫正后逐渐重新建立躯干平衡。结论后入路切除半椎体，畸形外观改善明显，脊柱侧后凸程度明显减轻，但要彻底切除半椎体上下生长板，减少凸侧生长点，防止复发；同时切除对侧附件，达到楔形截骨的效果，才能使矫形无张力，不易出现“拔钉”现象。Objetive To study the surgical method,clinical significance,management of complications and postoperative treatment of edge-shaped resection the hemivertebra from the back by the first stage in young children using the CD three-dimensional orthopedic system. Methods From July 2011 to June 2014,We a-dopted CD three-dimensional orthopedic system to correct 27 cases congenital kyphoscoliosis caused by hemi-vertebra deformities.There were 12 cases combination of scoliosis and hemivertebra.There were 15 cases com-bination of kyphoscoliosis and hemivertebra.There were 6 cases complex combination of butterfly vertebrae and vertebral segmentation defects.There was 1 case combined with Kidney deficiency.The lateral convex Cobb Angle was 24°to 45°from,an average of 32°,the sagittal convex Cobb Angle was 0°to 21°,on average of 15.5°,rotational deformity was Ⅰ ~Ⅲ degrees.The age ranged from 1 year 10 months to 5 years 8 months. All the patients adopted posterior fusion,the up and down vertebral body were fixed.If there was lesion of the vertebral body the upper or the downer were fixed.The concave side was fixed firstly,Wedge-shaped resection the hemivertebra were performed,vertebral body accessories and vertebral body were totally removed and then＆amp;nbsp;the convex side was fixed.Results After 1 ~36 months following up（16 months on average）,The lateral con-vex Cobb Angle was 5°to 15°from,on average was 11.5°,the average correct rate was 64.1%.The sagittal convex Cobb Angle was 0°to 10°,an average of 6°,rotational deformity was totally corrected.One pin was broken in one patient,but it had no symptoms and correction loss.There was no complications such as paraple-gia,rod broken,or pin pulled out.10 cases had the phenomenon of abdominal distension and abdominal pain, but they all relieved when they were symptomatic treated for 3 ~7 days.There was no wound infection.15 pa-tients had the compensatory side-bending at least 10 degrees,then they were treated by the braces and they were gradually established

关 键 词：脊柱/畸形 内固定器 治疗 儿童 

分 类 号：R726.8[医药卫生—儿科]