儿童先天性半椎体畸形的自然病程  

Natural course of congenital hemivertebral malformations in children

作　　者：郑光彬 王章富[1] 洪正华[1] Zheng Guangbin;Wang Zhangfu;Hong Zhenghua(Department of Orthopaedics,Taizhou Hospital of Zhejiang Province,Taizhou 317000,Zhejiang,China)

机构地区：[1]浙江省台州医院骨科,台州317000

出　　处：《脊柱外科杂志》2025年第1期18-23,共6页Journal of Spinal Surgery

基　　金：浙江省卫生健康科技计划项目(2022KY437)。

摘　　要：目的观察儿童先天性半椎体畸形的自然病程,探讨是否所有的先天性半椎体畸形都需要早期手术干预。方法回顾性分析2009年9月—2018年12月首次就诊的46例先天性半椎体畸形患儿的影像学资料。所有患儿初诊年龄为0~8.2(1.9±1.7)岁,末次随访年龄为3.1~14.0(7.7±2.8)岁,随访时间为2.0~12.1(5.8±2.7)年。在初诊和末次随访时的全脊柱正侧位X线片上测量并比较冠状位Cobb角、冠状面平衡(CVA)、矢状面平衡(SVA)、腰椎前凸角(LL)及双肩高度差。结果46例患儿中,18例末次随访时冠状位Cobb角较初诊时增加,由(29.20°±5.72°)增大至(33.19°±6.02°);28例较初诊时减小,由(33.58°±5.29°)减小至(26.95°±5.56°)。冠状位Cobb角增加组和减小组的患儿年龄差异有统计学意义(P<0.05)。以年龄分组,初诊年龄<2岁组患儿末次随访时冠状位Cobb角较初诊时减小,差异有统计学意义(P<0.05);初诊年龄≥2岁组患儿末次随访时冠状位Cobb角亦较初诊时减小,但差异无统计学意义(P>0.05)。结论先天性半椎体畸形患儿开始行走后,由于重力及自我姿势调整等因素作用,会出现冠状位Cobb角减小的情况,对于畸形较轻且尚未出现冠状面或矢状面失衡的初诊年龄<2岁的半椎体畸形患儿可选择严密的随访观察,以避免过早手术对患儿带来影响。Objective To observe the natural course of congenital hemivertebral malformations in children,and to investigate whether all congenital hemivertebral malformations require early surgical intervention.Methods Imaging data of 46 children with congenital hemivertebra malformation who were first diagnosed from September 2009 to December 2018 were retrospectively analyzed.The age of initial diagnosis was 0-8.2(1.9±1.7)years,the age of the final follow-up was 3.1-14.0(7.7±2.8)years,and the follow-up time was 2.0-12.1(5.8±2.7)years.The coronal Cobb angle,coronal vertical axis(CVA),sagittal vertical axis(SVA),lumbar lordosis(LL)and height difference between shoulders were measured and compared on whole spine anterior-lateral roentgenographs at the initial diagnosis and final follow-up.Results At the final follow-up,the coronal Cobb angle increased from(29.20°±5.72°)to(33.19°±6.02°)in 18 cases,and decreased from(33.58°±5.29°)to(26.95°±5.56°)in 28.The age difference between children with increase and decrease coronal Cobb angle was statistically significant(P<0.05).By age group,the coronal Cobb angle of children with initial diagnosis age<2 years old decreased at the final follow-up compared to the initial diagnosis,and the difference was statistically significant(P<0.05);the coronal Cobb angle of children with initial diagnosis age≥2 years old also decreased at the final follow-up compared to the initial diagnosis,but the difference was not statistically significant(P>0.05).Conclusions The coronal Cobb angle of children with congenital hemivertebra deformity will decrease after walking due to factors such as gravity and self-postural adjustment.For the hemivertebra deformity children with mild deformities and no coronal or sagittal plane imbalance at the initial diagnosis age of less than 2 years old,strict follow-up observation can be selected to avoid the influence of premature surgery on the children.

关 键 词：儿童 脊柱 骨疾病 发育性 脊柱侧凸 

分 类 号：R726.821.3[医药卫生—儿科]