摘要
目的对比前后路与后路半椎体切除术治疗半椎体畸形所致先天性脊柱侧后凸的疗效。方法2000年8月至2011年5月北京协和医院骨科治疗半椎体畸形所致先天性脊柱侧后凸44例，男21例，女23例；年龄2-17岁，平均年龄11．4岁。20例行前后路一期半椎体切除，后路矫形固定融合术；24例行后路一期半椎体切除，后路矫形固定融合术。所有病例术前、术后和随访时均拍摄站立位全脊柱X线片，测量冠状面和矢状面Cobb角及顶椎偏移；通过复习病例，记录相关并发症。结果全部病例随访24-72个月，平均39．2个月。两组患者年龄、性别、术前侧凸、后凸度数、顶椎偏移及术后随访时间对比差异无统计学意义（P〉0．05）；术中出血量、固定节段、术后侧凸、后凸度数及顶椎偏移对比差异无统计学意义（P〉0．05）。凸侧Bending像度数前后路组高于后路组（P〈0．05）；手术时间前后路组大于后路组（P〈0．05）。并发症包括：前后路组术中加压时椎弓根切割1例，随访发现代偿弯加重1例、曲轴失衡2例；后路组术中加压时椎弓根切割1例，术后螺钉拔出需翻修延长内固定1例。结论前后路与后路半椎体切除术在冠状面和矢状面均可获得相似的矫形效果。前后路半椎体切除术适用于畸形较僵硬的患者，对于骨龄小的患者，若阻滞范围不够，易发生曲轴失衡；后路半椎体切除术手术时间短、创伤小，但是应注意避免内固定相关并发症。
Objective To Compare the two techniques in the treatment of congenital kypho-scoliosis caused by fully-segmented hemivertebra. Methods 44 consecutive cases, 21 males and 23 females. The average age at surgery was 11.4 years ranging from 2 to 17 years, 20 patients underwent one-stage anterior and posterior hemivertebra resection and instrumentation. 24 patients underwent one-stage posterior hemivertebra resection and instrumentation. Long cassette standing radiographs were taken before and after surgery and at the final follow-up. The apical translation, the Cobb＇s angle in the coronal and sagittal plane were measured and analyzed. The medical records were reviewed and the complications were recorded. Results The average follow-up was 39. 2 months ranging from 24 to 72 months. The 2 groups did not demonstrate any significant differences in gender, age at surgery, preoperative and postoperative Cobb angle, blood loss, or fusion segments （all P 〉 0. 05 ） . However, the anterior and posterior group demonstrated a less curve flexibility and longer operative time compared with the posterior groups （ all P 〈 0. 05 ）. Complications：the anterior and posterior group included pedical cutting in 1 case, lumber curve decompensation in 1 case and crankshaft phenomenon in 2 cases. The posterior group included pedical cutting in 1 case and length of instrumentation in 1 case. Conclusions Two techniques are safe and effective procedure for the congenital kypho-scoliosis. Anterior and posterior hemivertebra resection is indicated to rigid deformity, and anterior epiphysiodesis is needed to avoid crankshaft phenomenon for patients at an earlier skeletal age. Posterior hemivertebra resection can save operation time and is less invasive compared with anterior-posterior approach.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第11期756-759,共4页
National Medical Journal of China
关键词
脊柱侧凸
脊柱融合术
内固定器
半椎体切除
Scoliosis
Spinal fusion
Internal fixators
Hemivertebra resection
