儿童先天性下腰椎和腰骶段半椎体畸形冠状面平衡状况与外科矫形选择  

The coronal plane balance and surgical orthopedic selection in children with lower vertebrae and lumbosacral hemivertebrae

作　　者：李民[1] 李楠楠[1] 吴玉泉[1] 宋海涛[1] 

机构地区：[1]中国人民解放军第107医院脊柱外科,山东烟台264001

出　　处：《临床和实验医学杂志》2017年第13期1334-1337,共4页Journal of Clinical and Experimental Medicine

摘　　要：目的分析不同矫形方式对儿童先天性下腰椎和腰骶段半椎体畸形冠状面平衡的影响及疗效。方法将20例先天性下腰椎和腰骶段半椎体畸形患儿纳入研究,按术前冠状面平衡状况分为A组(平衡)、B组(对侧偏离失衡)、C组(同侧偏离失衡)。均行一期后路半椎体切除联合椎弓根钉内固定植骨;A组行凸侧与凹侧压缩、撑开均等正畸;B组行单纯压缩;C组增加L_5/S_1反向凸侧撑开、凹侧压缩正畸。至少随访24个月,观察正畸情况。结果术后A组5例维持冠状面平衡,B组仅1例未纠正平衡,C组全部平衡;末次随访冠状面、矢状面Cobb角以及冠状面、矢状面平衡与术前比较均显著改善;末次随访盆骨倾斜角为(1.09±1.0)°,与术前差异显著(P<0.05)。末次随访冠状面、矢状面Cobb角正畸率分别为(68.34±9.25)%、(45.63±7.75)%。三组均无明显并发症和不良反应。结论冠状面失衡在儿童先天性下腰椎和腰骶半椎体畸形中较常见,一期后路半椎体联合椎弓根钉植骨具有一定疗效,需在术中根据患者冠状面排列情况进行恰当的正畸操作。Objective To analyze the effects of different orthopedic modalities on the coronal plane balance in children with lower lumbar and lumbosacral hemivertebrae.Methods Twenty cases of congenital lumbar and lumbosacral hemivertebrae children were divided into three groups： group A （balanced）,group B （deviated unbalance）,group C （unilateral deviation imbalance）.Group A was treated with hemi-vertebral resection combined with pedicle screw fixation;group A was treated with convex compression and concave compression,and propulsion was equally orthodontic;group B was compressed simply;group C increased L5/S1 Convex to the convex side,concave side compression orthodontic.At least 24 months follow-up observation of orthodontic conditions.Results The coronal balance was maintained in 5 patients in group A,and 1 patient in group B.The balance of coronal plane and sagittal plane and sagittal plane of coronal plane,sagittal plane were all significant,and last sagittal plane was （1.09＆#177;1.0）＆#176;,which was significantly different from that before operation （P＆lt;0.05）.The orthodontic rate of the coronal plane and the sagittal Cobb angle were （68.34＆#177;9.25） % and （45.63＆#177;7.75） %,respectively.There were no significant complications and adverse reactions in both groups.Conclusion Coronal plane imbalance is common in children with lumbar and lumbosacral hemivertebra malformations.One posterior hemivertebra combined with pedicle screw has a certain curative effect.It is necessary to perform proper operation according to the coronal arrangement of the patients.

关 键 词：儿童 半椎体畸形 冠状面平衡 外科矫形 

分 类 号：R726.8[医药卫生—儿科]