前后路一期半椎体切除术治疗先天性脊柱侧后凸的中期随访

目的 评价前后路一期半椎体切除术治疗完全分节半椎体畸形所致先天性脊柱侧后凸畸形的2～6年随访结果.方法 2000年8月至2006年10月,收治完全分节半椎体畸形所致先天性脊柱侧后凸患者20例,男女各10例;年龄5～16岁.平均11.7岁.半椎体分布:T5 1例.T6 3例,T7 1例,T8 4例,T10 3例,T11 2例,T12 2例,L1 1例,L2 1例.L3 2例.均行前后路一期半椎体切除及后路矫形固定融合术.内同定器械包括:CDH 4例,TSRH 9例,儿章TSRH 2例,Isola 2例,儿章Isola 2例,MossMiami 1例.所有病例术前、术后和随访时均拍摄站立位全脊柱正、侧位X线片,测量冠状面和矢状面Cobb角及顶椎偏移.复习病历以记录围手术期并发症和远期并发症.结果 全部病例随访24～72个月,平均40.5个月.手术时间140～520min,平均315 min.术中出血量180～1600ml,平均798 ml.固定融合节段为2～9节,平均4.7节.冠状面Cobb角由术前平均61.7°矫正至18.3°,矫正率为70.3%;后凸由术前平均48.2°矫正至16.6°;顶椎偏移由术前3.7 cm矫正至1.9 cm.并发症包括:术中加压时椎弓根切割1例,代偿弯加重1例,曲轴失衡2例.结论 前后路一期半椎体切除术在冠状面和矢状面均可获得良好的矫形,中期随访疗效可靠;但对于骨龄小的患者,若阻滞范围不够,仍可发生曲轴失衡.

Simultaneous anterior and posterior hemivertebra resection in the treatment of congenital kyphoscoliosis caused by fully-segmented hemivertebra

Objective To evaluate the long-term results of simultaneous anterior and posterior hemivertebra resection in the treatment of congenital kypho-scoliosis caused by fully-segmented hemivertebra. Methods Twenty consecutive cases, 10 males and 10 females, underwent one-stage anterior and posterior hemivertebra resection and instrumentation. All the hemivertebra were fully-segmented. The average age at surgery was 11.7 years, ranging from 5 to 16 years, and the average follow-up was 40.5 months, ranging from 24 to 72 months. Full-length standing radiographs were taken before and after surgery and at the final follow-up. The apical translation, the Cobb angle in the coronal and sagittal plane were measured and analyzed. The medical records were reviewed and the complications were recorded. The hemivertebra was located at T5, T7, L1, L2 in each 1 ease, T6, T10 in each 3 cases, T9 in 4 cases, T11 T12, L3 in each 2 cases. Results The average operative time was 315 min with a mean 798 ml of blood loss. The Cobb angle in the coronal plane was corrected from 61.7° to 18.3°, with a 70.3% of correction rate. The kyphosis was corrected from 48.2° to 16.6°. Apical translation was improved from 3.7 cm to 1.9 cm. The average fusion segments was 4.7, ranging from 2 to 9 segments. Complications included pediculus cutting in 1 case, lumbar curve decompensation in 1 case and crankshaft phenomenon in 2 cases. Conclusion Simultaneous anterior and posterior hemivertebra resection is a safe and effective procedure for delete congenital kypho-scoliosis caused by fully-segmented hemivertebra. Anterior epiphysiodesis is necessary to avoid crankshaft phenomenon for patients at an earlier skeletal age.