后路半椎体切除联合单侧单枚经S2骶髂螺钉固定治疗儿童腰骶部半椎体畸形的临床疗效

Clinical outcomes of posterior hemivertebra resection combined with unilateral single S2 alar-iliac screw fixation in the treatment of pediatric lumbosacral hemivertebra

中文关键词:  脊柱侧凸  半椎体畸形  骨螺钉  骨盆固定  经S2骶髂螺钉

英文关键词:Scoliosis  Hemivertebra  Bone screws  Pelvic fixation  S2 alar-iliac screw

中文摘要:

  【摘要】 目的：探讨后路半椎体切除联合单侧单枚经S2骶髂（S2 alar-iliac，S2AI）螺钉固定治疗儿童腰骶部半椎体畸形的短期临床疗效及并发症的发生情况。方法：回顾性分析2017年1月～2021年12月共16例接受后路半椎体切除联合单侧单枚经S2骶髂螺钉固定治疗的腰骶部半椎体患者的病历资料，男6例，女10例；年龄10.6±3.7岁（6~18岁），患者半椎体均位于L5与S1之间，均行腰骶部半椎体全椎体切除术（vertebral column resection，VCR），并采用单枚S2AI螺钉进行骨盆固定。在术前、术后以及末次随访时观察下列影像学指标：腰骶局部Cobb角、代偿弯Cobb角、局部后凸角（regional kyphosis，RK）、冠状面平衡（coronal balance distance，CBD）以及L5倾斜角（L5 tilt）。术前及末次随访时均采用脊柱侧凸研究学会问卷（scoliosis research society，SRS-22）以及Oswestry功能障碍指数（Oswestry disability index，ODI）评估生活质量，并记录并发症发生情况。结果：16例患者随访时间为12~26个月，平均18.7±3.6个月。术前腰骶部Cobb角为32.3°±8.7°，术后为8.6°±3.8°，较术前有明显改善（P＜0.001）；末次随访时为9.0°±3.7°，与术后相比均无统计学差异（P=0.110），随访中未见明显矫形丢失。代偿弯Cobb角术前为42.5°±9.5°，术后为18.2°±8.0°，较术前有明显改善（P＜0.001）；末次随访时为17.9°±8.1°，与术后相比均无统计学差异（P=0.120），随访中未见明显矫形丢失。L5倾斜角术前为17.5°±5.7°，术后纠正为6.5°±3.7°，差异有统计学意义（P＜0.001）；末次随访时为6.7°±3.8°，与术后相比无统计学差异（P=0.103），随访中无明显矫正丢失。CBD术前、术后分别为41.4±10.2mm、13.1±6.0mm，差异有统计学意义（P＜0.001）；末次随访时为14.0±6.5mm，与术后相比均无统计学差异（P=0.084），随访期间维持良好。RK角术前、术后以及末次随访时差异均无统计学意义。末次随访时SRS-22评分及ODI较术前明显改善（P＜0.001）。16例患者术中无体感诱发电位（somatosensory evoked potential，SEP）及运动诱发电位（motor evoked potential，MEP）信号的改变或丢失，随访中1例患者发生S2AI螺钉断裂，行翻修手术后效果良好；2例患者发生伤口感染，行清创手术4周后伤口基本愈合。结论：后路半椎体切除联合单侧单枚经S2AI螺钉固定治疗儿童腰骶部半椎体畸形中可获得满意的矫形效果，尤其对于冠状面失平衡有极好的矫正作用，在短期随访矫形效果维持良好。

英文摘要:

  【Abstract】 Objectives: To investigate the short-term clinical outcomes and complications of posterior hemivertebra resection and unilateral single S2 alar-iliac(S2AI) screw fixation in treating pediatric lumbosacral hemivertebra. Methods: The data of 16 patients undergone posterior hemivertebra resection and unilateral single S2AI screw fixation from January 2017 to December 2021 were retrospective reviewed. There were 6 males and 10 females, aged 10.6±3.7 years(6-18 years). All 16 patients(hemivertebra located between L5 and S1) underwent vertebral column resection(VCR) of lumbosacral hemivertebra and unilateral single S2AI screw pelvic fixation. The main imaging parameters including lumbosacral curve Cobb angle, compensatory curve Cobb angle, regional kyphosis(RK), coronal balance distance(CBD), and L5 tilt angle. The Scoliosis Research Society(SRS)-22 questionnaires and Oswestry disability index(ODI) were utilized to evaluate the patient-reported outcomes before and at final follow-up. Complications were also recorded. Result: The follow-up period was 18.7±3.6 months(12-26 months). The lumbosacral curve Cobb angle was 32.3°±8.7° before operation, which was improved to 8.6°±3.8° after operation, with significant difference(P<0.001), and 9.0°±3.7° at final follow-up, with no statistical difference comparing with the postoperative value(P=0.110) and no significant loss of correction during follow-up. The pre-operative, post-operative and final follow-up compensatory curve Cobb angles were 42.5°±9.5°, 18.2°±8.0°(vs preoperation, P＜0.001) and 17.9°±8.1°(vs postoperatin, P=0.120), with no significant loss of correction during follow-up. The pre-operative, post-operative and final follow-up L5 tilt angles were 17.5°±5.7°, 6.5°±3.7°(vs preoperation, P＜0.001) and 6.7°±3.8°(vs postoperatin, P=0.103), with no significant loss of correction during follow-up. The pre-operative, post-operative and final follow-up CBDs were 41.4±10.2mm, 13.1±6.0mm(vs preoperation, P＜0.001) and 14.0±6.5mm(vs postoperatin, P=0.084), well maintained during follow-up. RK angle was found with no statistical difference between preoperation, postoperation and final follow-up. At final follow-up, the SRS-22 score and ODI were significantly improved compared with those pre-operation(P＜0.001). In all 16 patients, there were no changes or losses in somatosensory evoked potential(SEP) and motor evoked potential(MEP) signals during the operation. One patient had S2AI screw breakage and underwent revision; Two patients suffered deep infection, and recovered at 4 weeks after debridement surgery. Conclusions: Posterior hemivertebra resection combined with unilateral single S2AI screw fixation can obtain satisfying correction in the treatment of pediatric lumbosacral hemivertebra, especially in the correction of coronal imbalance, which can be well maintained during short-term follow-up.