5岁以下儿童先天性颈胸段脊柱侧凸中长期手术疗效与并发症分析  

Analysis of the middle-term and long-term surgical efficacy in congenital cervicothoracic scoliosis among children younger than 5 years old and the complications

作　　者：张策飞 刘福云[1] 许可 胡伟明[1] 夏冰[1] 赵裕丰 王子立 李冲豪 Zhang Cefei;Liu Fuyun;Xu Ke;Hu Weiming;Xia Bing;Zhao Yufeng;Wang Zili;Li Chonghao(Department of Orthopedics,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第三附属医院骨科,郑州450052

出　　处：《中华小儿外科杂志》2025年第3期237-243,共7页Chinese Journal of Pediatric Surgery

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190384)。

摘　　要：目的评估5岁以下儿童先天性颈胸段脊柱侧凸的中长期手术疗效和并发症。方法回顾性分析2007年1月至2022年1月郑州大学第三附属医院骨科手术治疗的先天性颈胸段脊柱侧凸患儿27例的临床资料,其中男14例,女13例,年龄为(1.9±1.0)岁,范围在0.7~4.0岁。患儿术前均有不同程度的肩部不平衡和颈部倾斜。所有患儿均行一期后路矫形手术,其中18例患儿行半椎体切除联合椎弓根螺钉内固定术,7例患儿行单纯半椎体切除术不使用脊柱内固定,2例分节障碍型患儿行凸侧截骨和对侧骨桥松解联合椎弓根螺钉内固定术。在术前、术后及末次随访时全脊柱正侧位X线片上测量影像学指标,包括节段侧凸角、远端代偿弯、T1倾斜角、锁骨角、颈部倾斜角、冠状面平衡、节段后凸角和矢状面平衡。测量结果的比较采用配对t检验或Wilcoxon符号秩检验。记录并发症情况。结果所有患儿手术时间为(181.9±58.0)min,术中出血量为(242.2±130.8)ml,随访时间为(80.3±44.7)个月,固定节段为(3.3±1.3)个。节段侧凸角由术前47.6°±10.2°矫正到术后10.4°±6.5°(P<0.001),矫正率为(78.4±11.9)%,末次随访时为11.6°±7.9°。远端代偿弯由术前的22.1°±10.0°自发矫正到术后8.7°±5.3°(P<0.001),矫正率为(58.0±19.8)%,末次随访时为9.9°±6.2°。T1倾斜角由术前21.4°±9.0°矫正到术后8.2°±6.3°(P<0.001),矫正率为(61.8±21.9)%,末次随访时为9.0°±8.4°。锁骨角由术前7.8°±4.0°矫正到术后3.9°±2.9(°P<0.001),矫正率为(51.5±39.4)%,末次随访时为3.4°±3.0°。颈部倾斜角由术前11.4°±5.0°矫正到术后5.0°±3.9°(P<0.001),矫正率为(58.1±24.0)%,末次随访时为4.9°±4.2°。节段后凸角由术前20.8°±8.5°矫正到术后13.0°±4.4(°P<0.001),矫正率为(32.2±26.4)%,末次随访时为11.9°±4.7°。术后一过性神经根损伤3例,Horner综合征1例,胸腔积液1例。2例因矫正丢失行翻修手术。结论早Objective To evaluate the middle-term and long-term surgical outcomes of congenital cervicothoracic scoliosis in children younger than 5 years old and the complications.Methods The clinical data of 27 consecutive pediatric cases of congenital cervicothoracic scoliosis treated by orthopedic surgery in the Third Affiliated Hospital of Zhengzhou University from January 2007 to January 2022 were retrospectively analyzed,including 14 males and 13 females,with a mean age of 1.9±1.0(0.7-4.0)years.All patients had varying degrees of preoperative shoulder imbalance and neck tilt.They were all surgically treated with one-stage surgery via a posterior approach,of whom18 patients underwent hemivertebra resection with transpedicular screw fixation,7 underwent hemivertebra resection without internal fixation,and 2 with a failure of vertebral segmentation underwent convex osteotomy and contralateral bar release combined with pedicle screw internal fixation.Radiographic parameters,including segmental scoliosis,distal compensatory curve,T1 tilt,clavicle angle,neck tilt,coronal balance distance,segmental kyphosis,and sagittal vertical axis,were measured preoperatively,postoperatively,and at the last follow-up on the full-spine anteroposterior and lateral X-ray scans.The results of the measurements were statistically analyzed using the paired-sample t tests or Wilcoxon signed rank test.Complications were recorded.Results The mean operation time was 181.9±58.0min,with an average blood loss of 242.2±130.8ml.The mean follow-up period was 80.3±44.7months.An average of3.3±1.3 segments was fused.The segmental scoliosis was significantly improved from 47.6±10.2°preoperatively to 10.4±6.5°postoperatively(P<0.001),with a correction rate of 78.4%±11.9%and segmental scoliosis of 11.6°±7.9°at the last follow-up.The distal compensatory curve was spontaneously corrected from 22.1±10.0°preoperatively to 8.7±5.3°postoperatively(P<0.001),with a correction rate of 58.0%±19.8%and distal compensatory curve of 9.9°±6.2°at the last

关 键 词：脊柱侧凸 颈椎 胸椎 矫形术 儿童 

分 类 号：R726.8[医药卫生—儿科]