单一后路半椎体选择性部分切除内固定术治疗先天性脊柱侧后凸畸形
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摘要
背景半椎体畸形是先天性脊柱侧后凸畸形中最为常见的一种。由半椎体所致的脊柱侧后凸多为进展性,保守治疗难以矫治和预防,通常需要进行手术治疗。当前治疗半椎体畸形常用的手术方式均存在各自的缺陷和不足。目前,对尚有较大生长潜能的、完全分节型的半椎体,多数学者主张行半椎体完全切除内固定矫形。完全切除固然能获得较满意的矫形效果,但创伤较大,并发症较多；对此类病人,是否都需要行半椎体完全切除术?迄今为止,国际上尚未有通过单一后路半椎体选择性部分切除内固定术治疗半椎体畸形的报道。
目的评估通过单一后路半椎体选择性部分切除内固定术治疗9-14岁、Risser征0-3级、总侧凸角小于60°的先天性脊柱侧后凸畸形患者的矫形效果。
方法本研究共纳入17例病例,均为完全分节型半椎体,平均年龄为10.8岁,平均Risser征为1.82级,平均随访时间为20.12个月,采用单一后路半椎体选择性部分切除内固定术进行治疗。通过对患者术前、术后及末次随访的节段侧凸角、总侧凸角及节段后凸角等指标的测量,评估治疗效果。
结果所有患者术后均未出现感染或神经系统并发症。节段侧凸角术前平均为38.70,术后平均为13.6°,矫形率为64.9%,末次随访平均为16.6°,丢失3.0°；总侧凸角术前平均为42.9°,术后平均为14.7°,矫形率为65.7%,末次随访平均为17.5°,丢失2.8°；节段后凸角术前平均为22.6°,术后平均为6.2°,矫形率为72.6%,末次随访平均为6.9°,丢失0.7°。
结论对于9-14岁、Risser征O-3级、总侧凸角小于60°、由半椎体所致的先天性脊柱侧后凸畸形患者,单一后路半椎体选择性部分切除内固定术可通过个体化的治疗,去除多余的生长中心,平衡脊柱两侧的生长,从而取得令人满意的临床效果。
BACKGROUND Hemivertebra is the most common type of congenital kyphoscoliosis. Kyphoscoliosis caused by a hemivertebra is mostly progressive and usually require surgery, as it is difficult to correct and prevent by conservative treatment. The commonly used operation methods for kyphoscoliosis caused by a hemivertebra have their own flaws and shortcomings. At present, most scholars advocate complete resection with internal fixation for full segmented hemivertebra with large growth potential. Complete hemivertebra resection can gain great orthopedic effect indeed, but it is also accompanied by severer trauma and more complications. Whether all of this kind of patient needs complete hemivertebra resection? Up to now, there is none of research report of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis.
OBJECTIVE To assess the correction effect of selective-partial hemivertebra resection and instrumentation via posterior approach only for patients of congenital kyphoscoliosis between9-14years old, with Risser sign between0-3grade, and with Cobb angle less than60degrees.
METHODS This study includes17cases treated by selective-partial hemivertebra resection and instrumentation via posterior approach only. The mean age is10.8years. The mean Risser sign is1.82. The average time of follow-up is20.12months. The classification of hemivertebra is fall segmented hemivertebra. The Cobb angles of the main curves, segmental curves and segmental kyphotic curves are measured before and after operation, and at the latest follow-up. The data is analyzed to evaluate the correction effect.
RESULTS There is none of infections and none of neurological deficits. The correction rate of the segmental curve is64.9%, as the mean Cobb angle is38.7degrees before operation,13.6degrees after operation, and16.6degrees at the latest follow-up. The correction rate of the main curve is65.7%, as the mean Cobb angle is42.9degrees before operation,14.7degrees after operation, and17.5degrees at the latest follow-up. The correction rate of the segmental kyphotic curve is72.6%, as the mean segmental kyphotic angle is22.6degrees before operation,6.2degrees after operation, and6.9degrees at the latest follow-up.
CONCLUSIONS For the patients who are between9-14years old, with the Risser sign between0-3grade, and with the Cobb angles less than60degrees, the selective-partial hemivertebra resection and instrumentation via posterior approach only can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.
目的评估通过单一后路半椎体选择性部分切除内固定术治疗9-14岁、Risser征0-3级、总侧凸角小于60°的先天性脊柱侧后凸畸形患者的矫形效果。
方法本研究共纳入17例病例,均为完全分节型半椎体,平均年龄为10.8岁,平均Risser征为1.82级,平均随访时间为20.12个月,采用单一后路半椎体选择性部分切除内固定术进行治疗。通过对患者术前、术后及末次随访的节段侧凸角、总侧凸角及节段后凸角等指标的测量,评估治疗效果。
结果所有患者术后均未出现感染或神经系统并发症。节段侧凸角术前平均为38.70,术后平均为13.6°,矫形率为64.9%,末次随访平均为16.6°,丢失3.0°；总侧凸角术前平均为42.9°,术后平均为14.7°,矫形率为65.7%,末次随访平均为17.5°,丢失2.8°；节段后凸角术前平均为22.6°,术后平均为6.2°,矫形率为72.6%,末次随访平均为6.9°,丢失0.7°。
结论对于9-14岁、Risser征O-3级、总侧凸角小于60°、由半椎体所致的先天性脊柱侧后凸畸形患者,单一后路半椎体选择性部分切除内固定术可通过个体化的治疗,去除多余的生长中心,平衡脊柱两侧的生长,从而取得令人满意的临床效果。
BACKGROUND Hemivertebra is the most common type of congenital kyphoscoliosis. Kyphoscoliosis caused by a hemivertebra is mostly progressive and usually require surgery, as it is difficult to correct and prevent by conservative treatment. The commonly used operation methods for kyphoscoliosis caused by a hemivertebra have their own flaws and shortcomings. At present, most scholars advocate complete resection with internal fixation for full segmented hemivertebra with large growth potential. Complete hemivertebra resection can gain great orthopedic effect indeed, but it is also accompanied by severer trauma and more complications. Whether all of this kind of patient needs complete hemivertebra resection? Up to now, there is none of research report of selective-partial hemivertebra resection and instrumentation via posterior approach only for congenital kyphoscoliosis.
OBJECTIVE To assess the correction effect of selective-partial hemivertebra resection and instrumentation via posterior approach only for patients of congenital kyphoscoliosis between9-14years old, with Risser sign between0-3grade, and with Cobb angle less than60degrees.
METHODS This study includes17cases treated by selective-partial hemivertebra resection and instrumentation via posterior approach only. The mean age is10.8years. The mean Risser sign is1.82. The average time of follow-up is20.12months. The classification of hemivertebra is fall segmented hemivertebra. The Cobb angles of the main curves, segmental curves and segmental kyphotic curves are measured before and after operation, and at the latest follow-up. The data is analyzed to evaluate the correction effect.
RESULTS There is none of infections and none of neurological deficits. The correction rate of the segmental curve is64.9%, as the mean Cobb angle is38.7degrees before operation,13.6degrees after operation, and16.6degrees at the latest follow-up. The correction rate of the main curve is65.7%, as the mean Cobb angle is42.9degrees before operation,14.7degrees after operation, and17.5degrees at the latest follow-up. The correction rate of the segmental kyphotic curve is72.6%, as the mean segmental kyphotic angle is22.6degrees before operation,6.2degrees after operation, and6.9degrees at the latest follow-up.
CONCLUSIONS For the patients who are between9-14years old, with the Risser sign between0-3grade, and with the Cobb angles less than60degrees, the selective-partial hemivertebra resection and instrumentation via posterior approach only can balance the growth on the two sides of the spine, and achieve satisfactory therapeutic effect through individualized treatment of extra growth center resection.
引文
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