儿童下腰椎和腰骶段半椎体畸形冠状面平衡状况与外科矫形选择

Coronal balance and surgical strategy of pediatric lumbar and lumbosacral hemivertebrae

中文关键词:  儿童脊柱畸形  先天性侧凸  冠状面平衡  腰骶椎  半椎体

英文关键词:Pediatric spinal deformity  Congenital scoliosis  Coronal balance  Lumbosacral vertebra  Hemivertebrae

中文摘要:

  【摘要】 目的：评估儿童下腰椎及腰骶段半椎体畸形冠状面平衡情况，分析不同外科矫形方式的选择和临床疗效。方法：回顾分析2005年1月～2013年12月我院收治的14例先天性脊柱侧凸患者，平均年龄7.8±3.3岁（3～10岁）。L4半椎体4例，L5半椎体7例，S1半椎体3例。根据术前冠状面平衡情况分为3组：A组冠状面平衡，C7铅垂线偏离骶骨正中平分线（CSVL）≤2cm；B组为C7铅垂线位于半椎体的对侧（偏离CSVL＞2cm）；C组为C7铅垂线位于半椎体的同侧（偏离CSVL＞2cm）。所有患者均采用一期后路半椎体切除联合椎弓根螺钉内固定矫形植骨融合术式。矫形方式：A组中凸侧与凹侧撑开、压缩力均等；B组半椎体侧单纯压缩；C组增加L5/S1节段“反向”凸侧撑开、凹侧压缩的矫形操作。随访观察各组患者畸形矫正情况。结果：所有病例随访24~68个月，平均33±12个月。术前冠状面排列中平衡4例（29%），失平衡10例（71%）。术前冠状面Cobb角平均36.8°，末次随访时平均12.1°±8.0°（P=0.000），最终矫正率67.1%。术前的冠状面平衡为6~53mm，平均30.6±14.9mm，末次随访时冠状面平衡为0~44mm，平均10.7±10.9mm（P=0.001）。其中，A组患者4例，术前与术后均维持了冠状面平衡；B组患者6例，术后有1例患者冠状面仍然失平衡；C组患者4例，术后均恢复了冠状面平衡。结论：儿童下腰椎和腰骶段的半椎体畸形冠状面失平衡发生率较高，一期后路半椎体切除联合椎弓根内固定、结合不同冠状面排列情况采取恰当矫形方式，可能获得满意的冠状面平衡和临床疗效。

英文摘要:

  【Abstract】 Objectives: To asses the coronal balance in pediatric lumbar and lumbosacral hemivertebrae(HV), and to evaluate the surgical outcome of one stage posterior hemivertebra resection and pedicle screw instrumentation. Methods: A retrospective review of 14 pediatric patients receiving surgical treatment in our department from January 2015 to December 2013 was carried out. The mean age at the time of surgery was 7.8±3.3 years(range, 3-10 years). The hemivertebrae involved L4 in four cases, L5 in seven cases and S1 in three cases. Patients were classified into three groups according to the preoperative coronal balance. Group A had coronal balance, the distance between C7 plumb line and central sacral vertical line(CSVL) was less than 2cm. Group B was termed as C7 plumb line located at contralateral side of HV and deviated from CSVL of more than 2cm. Group C was also C7 plumb line deviated from CSVL of more than 2cm but located at ipsilateral side of HV. All patients underwent one stage posterior HV resection and pedicle screw instrumentation. In group A, distraction at concavity and compression at convex side were used equally to maintain coronal balance. In group B, compression and gap closing following HV resection was the main procedure. In group C, additional distraction at convex and compression at concave side were used at L5-S1 segment, following HV resection and gap closing. Results: The mean follow-up period was 33±12 months(range, 24-68 months). 4 cases(29%) had preoperative coronal balance, while the other 10 cases had preoperative imbalance. The coronal Cobb angle improved form 36.8°±6.9° at preoperation to 12.1°±8.0° at final follow-up(P=0.000), with a correction rate of 67.1%. The coronal balance improved from 30.6mm(range, 6-53mm) at preoperation, to 10.7±10.9mm(range, 0-4mm) at final follow-up(P=0.001). There were 4 cases in group A, 6 cases in group B, 4 cases in group C. All patients retained coronal balance except one case in group B developed coronal decompensation postoperatively. Conclusions: There is a high rate of coronal imbalance in pediatric lumbar and lumbosacral hemivertebra patients. One stage posterior hemivertebra resection and pedicle screw instrumentation is of highly satisfied.