后路半椎体切除矫形内固定术治疗颈胸段半椎体畸形的疗效分析

Outcome analysis of posterior hemivertebra resection and correctional surgery for the treatment of cervicothoracic hemivertebra deformity

中文关键词:  半椎体畸形  半椎体切除术  颈胸段  矫形效果

英文关键词:Hemivertebra deformity  Hemivertebra resection  Cervicothoracic hemivertebra  Correction outcomes

中文摘要:

  【摘要】 目的：评估一期后路半椎体切除矫形内固定术治疗颈胸段半椎体畸形的疗效。方法：回顾性分析2010年6月~2017年4月在我院行一期后路半椎体切除矫形内固定手术且满足入选标准的32例颈胸段半椎体畸形患者，男15例，女17例，年龄5~18岁（10.1±4.2岁）。单个半椎体25例，2个半椎体7例；C7 1例，T1 5例，T2 12例，T3 10例，T4 11例。术前均有不同程度的肩部不平衡和颈部倾斜。在术前、术后和末次随访时的站立位全脊柱X线片上测量局部侧凸角、锁骨角、T1倾斜角、颈部倾斜、头部偏斜以及局部后凸角等参数，采用配对t检验进行比较分析。结果：32例患者均完成矫形手术，手术时间175~275min（223.8±41.6min），出血量310~470ml（342.3±45.9ml）。术中胸膜撕裂1例，术后出现Horner综合征1例，上肢神经根性疼痛2例，经保守治疗后均恢复。共置入261枚椎弓根螺钉，55枚穿破椎弓根皮质，但均未侵犯脊髓及周围脏器和血管，未行翻修手术。术后随访12~48个月（19.3±10.5个月），局部侧凸角由术前41.1°±12.3°矫正到术后17.5°±6.7°（P＜0.001），末次随访时为20.1°±5.8°，与术后比较无显著性差异（P=0.102）；局部后凸角由术前21.5°±9.1°矫正到术后16.8°±6.3°（P＜0.05），末次随访时为17.5°±4.9°（P=0.622）；远端代偿弯由术前16.9°±5.3°减少到术后12.2°±5.5°（P＜0.001），末次随访时为15.5°±7.7°（P=0.053）。T1倾斜角、锁骨角、颈部倾斜以及头部偏斜在术后均较术前得到显著性改善（P＜0.05），末次随访时影像学观察指标进一步改善（P＜0.05）。结论：颈胸段半椎体畸形患者行一期后路半椎体切除矫形内固定术手术时间短、创伤小，可有效矫正侧凸畸形，获得满意的治疗效果。

英文摘要:

  【Abstract】 Objectives: To evaluate the radiographic outcomes of one-stage posterior hemivertebra resection in the treatment of cervicothoracic hemivertebra deformity. Methods: From June 2010 to April 2017, 32 cases with cervicothoracic hemivertebra deformity who were managed by one-stage posterior hemivertebra resection and met the inclusion criteria were reviewed. There were 15 boys and 17 girls with a mean age of 10.1±4.2 years(range, 5-18 years). There were 25 cases with one hemivertebra and 7 cases with two hemivertebrae. The hemivertebra located in C7 in 1 patient, T1 in 5 patients, T2 in 12 patients, T3 in 10 patients and T4 in 11 patients. Before surgery, all patients had torticollis and shoulder imbalance. The following radiographic parameters were measured: local scoliosis, local kyphosis, shoulder balance, neck tilt, head shift, and sagittal parameters. The paired Student′s t test was used to analyze the data. Results: The operation time was 175-275 minutes(223.8±41.6min), the blood loss was 310-470ml(342.3±45.9ml). There were one case with Horner syndrome, two cases with transient radicular pain of arm after surgery, and one case with pleural tear during surgery, all these patients recovered after conservation treatment. A total of 261 pedicle screws was placed. The incidence of pedicle screw malposition was 7.3% without any neurovascular injury. The mean follow-up period was 19.3±10.5 months. Local scoliosis was significantly corrected from 41.1°±12.3° preoperatively to 17.5°±6.7° postoperatively(P＜0.001) and 20.1°±5.8° at last follow-up with no significant correction loss(P=0.102). Local kyphosis was significantly corrected from 21.5°±9.1° preoperatively to 16.8°±6.3° postoperatively(P＜0.05) and 17.5°±4.9° at last follow-up with no significant correction loss(P=0.102). The distal compensatory curve was corrected from 16.9°±5.3° preoperatively to 12.2°±5.5° postoperatively(P＜0.001), which slightly increased to 15.5°±7.7° at last follow-up(P=0.053). T1 tilt, clavicle angle, neck tilt and head shift were significantly improved at postoperation and no significant correction loss was found during follow-up. Conclusions: For patients with cervicothoracic hemivertebra deformity, one-stage posterior hemivertebra resection with instrumentation has shorter operation time, less operation wound and optimistic deformity correction.