后路半椎体切除短节段固定治疗儿童腰骶部半椎体畸形的中远期疗效

Posterior-only hemivertebra resection and short segmental fusion in pediatric lumbosacral hemivertebra

中文关键词:  先天性脊柱侧凸  腰骶部  半椎体  短节段固定  冠状面平衡  矫形效果

英文关键词:Congenital scoliosis  Lumbosacral  Hemivertebra  Short segmental fusion  Coronal balance  Correction outcomes

中文摘要:

  【摘要】　目的：评估后路半椎体切除短节段固定治疗儿童腰骶部半椎体畸形的中远期疗效及并发症。方法：回顾性分析2003年3月～2013年2月在我院行腰骶部半椎体切除短节段固定术、随访5年以上的21例患者的临床资料和影像学资料，其中男13例，女8例，手术时年龄3～13岁（8.4±2.9岁）。半椎体位于L4/5 11例，位于L5/S1 10例。分别于术前、术后即刻、术后2年和末次随访时的站立位X线片上测量冠状面上局部侧凸角、代偿弯Cobb角、上端固定椎倾斜角、躯干偏移和矢状面上局部后凸角、胸椎后凸角、腰椎前凸角和矢状面平衡距离（SVA），对冠状位平衡状态进行分型；并记录术后和随访时的并发症。结果：术后随访5.0～13.0年（6.5±2.4年），固定节段2～4个（2.9±0.6个）椎体。患者术前腰骶部原发弯Cobb角为29.8°±10.1°，术后矫正至6.5°±5.1°（P<0.001），矫正率为（76.2±18.5）%；术后2年和末次随访时分别为7.4°±5.4°和7.8°±6.1°，与术后即刻比较无显著性差异（P>0.05）。术前冠状面平衡状态A型5例，B型6例，C型10例，术后和末次随访时均有显著性改善。术前冠状面躯干偏移为24.5±14.2mm，术后矫正至14.6±11.9mm（P<0.01），矫正率为（41.9±59.3）%；术后2年及末次随访时分别为12.0±8.9mm 和9.8±8.0mm。近端代偿弯由术前的22.9°±11.1°矫正到术后8.5°±5.2°（P<0.001），矫正率为（61.3±20.5）%；术后2年及末次随访时分别为10.1°±6.0°和11.9°±6.5°，与术后即刻比较无显著性差异（P>0.05）。术前上端固定椎倾斜角为14.4°±7.1°，术后即刻为2.6°±3.8°（P<0.05）；术后2年及末次随访时分别为3.1°±4.0°、3.8°±4.2°，与术后即刻比较无显著性差异（P>0.05）。矢状面上，术后及随访时的局部后凸角、胸椎后凸角、腰椎前凸角、SVA与术前比较均无显著性差异（P>0.05）。1例患者术中矫形时发生凸侧椎弓根螺钉切割，1例患者术后出现短暂性右足背伸肌力下降，保守治疗3个月后完全恢复。2例代偿弯进展，1例行翻修手术。结论：继发于腰骶部半椎体的先天性脊柱畸形患者行单一后路腰骶部半椎体切除短节段固定可明显矫正腰骶部原发畸形，改善近端代偿弯及冠状面失平衡，并且矫形效果在远期随访过程中能得到良好的维持。

英文摘要:

  【Abstract】 Objectives: To investigate the radiographic outcomes and complications after one-stage posterior hemivertebra resection and short segmental fusion for congenital scoliosis(CS) secondary to lumbosacral hemi-vertebra(HV). Methods: The young CS patients with lumbosacral hemivertebra who underwent hemivertebra resection and short segmental fusion form March 2003 to February 2013 and experienced more than 5 years follow-up were reviewed retrospectively. A total of 21 patients with an average age of 8.4 years at surgery was recruited. Among whom, there were 13 males and 8 females. HV was located at L4-L5 in 11 cases and L5-S1 in 10 cases. Radiological parameters including segmental curve, compensatory curve, upper instrumented vertebra(UIV) tilt, gravity trunk shift and segmental kyphosis, thoracic kyphosis, lumbar lordosis and SVA were measured on the X-rays before operation, immediately after operation, 2 years after operation and at the final follow-up. Patients were classified according to preoperative C7 translation. Complications were also recorded. Results: The follow-up time was 5.0-13.0 years(6.5±2.4 years). The fusion segments were 2-4 levels(2.9±0.6 levels). The segmental curve was corrected from 29.8°±10.1° before operation to 6.5°±5.1° immediately after operation(P<0.001), and 7.4°±5.4° and 7.8°±6.1° at 2 years after operation and the final follow-up respectively. With regard to preoperative coronal balance, 5 patients were identified with type A, 6 with type B and 10 with type C. The coronal imbalance was significantly corrected after operations in the three groups. The gravity trunk shift improved from 24.5±14.2mm to 14.6±11.9mm immediately after surgery (P<0.01), to 12.0±8.9mm and 9.8±8.0mm at 2 years after operation and the final follow-up respectively. The compensatory curve was spontaneously corrected from 22.9°±11.1° preoperatively to 8.5°±5.2° immediately after operation(P<0.001), 10.1°±6.0° and 11.9°±6.5° at 2 years after operation and the final follow-up, respectively. The UIV tilt improved from 14.4°±7.1° preoperatively to 2.6°±3.8° immediately after operation(P<0.05), 3.1°±4.0° and 3.8°±4.2° at 2 years after operation and the final follow-up. No significant statistical difference of sagittal parameters was observed(P>0.05). One patient experienced pedicle fracture during the operation. One patient had transient neurologic deficit after operation and recovered 3 months later. Two patients encountered compensatory curve progression and one patient received revision surgery. Conclusions: One-stage posterior hemivertebra resection and short segmental fusion is an effective procedure for congenital scoliosis secondary to lumbosacral hemivertebra, and the correction can be well maintained during the longitudinal follow-up.