骨桥切断凹侧松解半椎体切除治疗儿童轻中度混合型先天性脊柱侧后凸

Application of cutting bone bridge and releasing concave side and hemivertebra resection for mild to moderate spinal congenital kyphoscoliosis in children

中文关键词:  先天性脊柱侧凸  混合型  手术  儿童

英文关键词:Congenital scoliosis  Mixed type  Operation  Children

中文摘要:

  【摘要】 目的：探讨骨桥切断、凹侧松解、半椎体切除治疗儿童轻中度混合型先天性脊柱侧后凸的效果。方法：2001年1月~2013年1月对32例椎体分节障碍混合椎体形成障碍的先天性脊柱侧后凸患儿行后路半椎体切除的同时，行凹侧骨桥切断、松解，利用椎弓根钉棒系统矫形。其中男10例，女22例；年龄4～12岁（7.8±4.2岁）。侧凸Cobb角58.3°±12.5°（35°～78°），后凸Cobb角47.6°±15.6°（13°～55°），躯干偏移18.2±5.5mm（11～32mm）。畸形位于T7～L3，顶椎位于胸段11例、胸腰段13例、腰段8例。合并脊髓纵裂3例，神经根囊肿1例，脊髓拴系综合征1例。结果：手术时间230±125min（160～270min），术中出血量590±113ml（310～850ml）。术中2例置钉过程中出现椎弓根骨折，调整固定节段后完成矫形。术后1例出现单侧下肢麻木无力，予甲强龙及脱水剂治疗1周后症状缓解；2例出现脑脊液漏。术后脊柱侧凸Cobb角13.8°±7.1°（5°～28°），矫正率（76.3±9.5）％；脊柱后凸15.1°±3.9°（0～20°），矫正率（68.3±11.2）％；躯干偏移距离3.1±2.3mm（0~11.6mm）。随访18.4±12.6个月（12～60个月），末次随访时侧凸矫正率丢失（3.9±1.6）%，后凸矫正率丢失（2.3±0.9）%，无内固定松动及断裂发生。结论：对儿童轻中度混合型先天性脊柱侧后凸畸形，行后路一期半椎体切除的同时，将凹侧分节障碍的骨桥予以切断、松解，再通过椎弓根钉棒系统矫形，可获得满意的矫形效果。

英文摘要:

  【Abstract】 Objectives: To investigate the effect of cutting bone bridge, releasing concave side， semicorpectomy for mild to moderate spinal congenital kyphoscoliosis in children. Methods: From January 2001 to January 2013, 32 patients with spine congenital scoliosis combined with vertebral dyssegmentation and mixed vertebral body dysformation were treated with one-stage posterior hemivertebra resection, resection of bone bridge at concave side, release, and deformity correction through the pedicle screw system. There were 10 males and 22 females with the age ranging from 4 to 12 years old. The Cobb angle of scoliosis was 35°-78°(mean 58.3°±12.5°); kyphosis Cobb angle was 13°-55°( mean 47.6°±15.6°). Trunk shift was 11-32mm(average 18.2±5.5mm). The deformity located from T7 to L3, 11 cases had apical vertebra in thoracic, 13 cases in thoracolumbar, 8 cases in lumbar. Diastematomyelia was noted in 3 cases(T10-L1 in 1 case, T12-L2 in 1 case, T12 in 1 case), the lumbar nerve root cyst was noted in one case, tethered cord syndrome was noted in one case. Results: The operation time was 160-270min(average, 230±125min). Blood loss was 310-850ml(average 590±113ml). 2 cases were noted pedicle fracture during pedicle screw placement, then the fixed segment was adjusted. After operation, 1 case suffered from unilateral lower extremity weakness and numbness, which resolved by administration of methylprednisolone and dehydrating medicine for 1 week, cerebrospinal fluid leakage occurred in 2 cases. Postoperative spinal scoliosis Cobb angle was 5°-28°(average 13.8°±7.1°), with the correction rate of(76.3±9.5)％; kyphosis angle was 0-20°(average 15.1°±3.9°), with the correction rate of (68.3±11.2)％; trunk shift distance was 0-11.6mm(average 3.1±2.3mm). Follow-up was from 12 to 60 months(average 18.4±12.6 months), at final follow-up, the scoliosis correction rate decreased by (3.9±1.6)%, and the rate of kyphosis correction decreased by (2.3±0.9)%. No instrument failure was noted. Conclusions: For mild to moderate congenital spinal kyphosis, one-stage posterior hemivertebra resection, resection of bone bridge at concave side, release, and instrumentation have satisfactory outcome.