一期后路半椎体切除、短节段固定治疗幼儿先天性多发半椎体畸形伴脊柱侧凸  

Mid-term outcomes of one-stage posterior-only jumping hemivertebra resections and short fusions for children with congenital scoliosis secondary to multiple hemivertebrae

作　　者：毛赛虎[1] 李松[1] 朱泽章[1] 马彦宇 刘臻[1] 史本龙[1] 孙旭[1] 乔军[1] 王斌[1] 俞杨[1] 邱勇[1] Mao Saihu;Li Song;Zhu Zezhang;Ma Yanyu;Liu Zhen;Shi Benlong;Sun Xu;Qiao Jun;Wang Bin;Yu Yang;Qiu Yong(Department of Spine Surgery,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华骨科杂志》2021年第23期1673-1682,共10页Chinese Journal of Orthopaedics

基　　金：江苏省临床医学中心(YXZXA2016009)。

摘　　要：目的评估一期单纯后路跳跃式半椎体(hemivertebra,HV)切除、跳跃式短节段内固定治疗多发性HV所致先天性脊柱侧凸(congenital scoliosis,CS)的安全性和有效性。方法回顾性分析2010年1月至2017年12月收治并行一期后路跳跃式HV切除、短节段内固定融合治疗多发HV所致CS患儿13例,男4例,女9例;年龄(3.7±1.2)岁(范围1.4~4.9岁)。选择导致局部侧凸、侧后凸畸形或冠状面偏移的责任半椎体作为切除的目标,先远端后近端分别切除半椎体并水平化固定椎。主要观察指标为术前、术后即刻及末次随访时的近端和远端侧凸Cobb角、冠状面平衡、局部后凸Cobb角及脊柱生长高度(近端和远端内固定长度、T1~S1长度)的改善情况;同时记录近、远期并发症,包括生长过程中脊柱冠状面(失代偿定义为术后侧凸进展>20°)、矢状面(后凸进展定义为上、下内固定间后凸加重>40°)的再进展情况,以及内固定相关并发症(螺钉切割、螺钉误置)。结果每例患儿均切除2个HV,8例(61.5%)半椎体位于脊柱两侧,5例(38.5%)位于脊柱同侧。术后随访时间为(6.2±3.3)年(范围2.0~10.5年)。术前近端侧凸Cobb角和远端侧凸Cobb角分别为36.7°±11.8°和35.2°±7.8°,术后分别矫正至9.7°±6.6°和6.1°±4.1°,末次随访时维持在14.3°±5.4°和8.0°±4.6°,差异圴有统计学意义(F_(近端)=31.249,F_(远端)=93.830,P<0.001),术后改善率分别为73.6%±19.6%和82.4%±11.7%(t_(近端)=6.888,t_(远端)=10.954,P<0.001),末次随访时丢失率为15.8%±26.9%和6.9%±7.0%。冠状面平衡术前为(17.2±14.8)mm,术后改善至(-0.2±15.7)mm,末次随访时维持在(0±18.4)mm(F=4.137,P=0.024)。T1~S1长度术前为(256.3±24.0)mm,术后(273.8±27.3)mm,末次随访时增加至(333.2±33.4)mm,差异有统计学意义(F=6.704,P=0.003),术后较术前略有增加(t=0.680,P=0.527),末次随访时较术后明显增加(t=2.986,P<0.001)。7例患儿术前存在局部后凸畸形,由术前32.2°±13.6�Objective To evaluate the safety and efficacy of one-stage posterior-only jumping hemivertebra(HV)resection combined with respective short fusions in the treatment of congenital scoliosis(CS)caused by multiple HVs.Methods All of 13 consecutive patients with multiple HVs treated surgically from January 2010 to December 2017 were retrospectively reviewed,including 4 males and 9 females with a mean age of 3.7±1.2 years.One child had 4 HVs,and the rest had 2 HVs.The responsible HVs causing local scoliosis/kyphosis deformity or coronal plane deviation were selected as the target of resection.The distal HV was removed firstly and then the proximal one was resected;both of the fixation vertebraes were horizontalized during surgery.The clinical and imaging data of the children before the initial operation,immediately after the operation and at the latest follow-up were collected,and the short-term and long-term complications related to surgery were recorded.The data were evaluated on the whole-standing spine anteroposterior and lateral films,including the corrections of proximal and distal main curves,coronal balance,local kyphosis,and the improvement of spinal growth height(upper and lower internal fixation length,T1-S1 length).At the same time,the re-progression of coronal and sagittal deformities of the spine during growth was recorded(coronal decompensation:emerging postoperative curve progression more than 20°;kyphosis progression:kyphosis aggravation between upper and lower internal fixation more than 40°)and internal-fixation-related complications(screw cutting,screw malposition)were recorded.Results Dual HVs were resected in each child,of which 8(61.5%)were located on contralateral side of the spine,and 5(38.5%)were located on ipsilateral side of the spine.The follow-up time was 6.2±3.3 years(range 2.0-10.5 years)after surgery.The Cobb angles of proximal and distal main curves were 36.7°±11.8°and 35.2°±7.8°respectively before surgery and were corrected to 9.7°±6.6°and 6.1°±4.1°respectively after s

关 键 词：胸椎 腰椎 躯干发育异常 脊柱侧凸 脊柱融合术 

分 类 号：R726.8[医药卫生—儿科]