伴有面部不对称的先天性颈胸段/上胸段侧凸畸形后路半椎体切除术后面部再塑形

Changes in facial symmetry after posterior hemivertebra resection in children with congenital cervicothoracic/upper thoracic scoliosis

中文关键词:  先天性脊柱侧凸  颈胸段/上胸段侧凸  半椎体切除  面部不对称

英文关键词:Congenital scoliosis  Cervicothoracic/upper thoracic scoliosis  Hemivertebra resection  Facial asymmetry

中文摘要:

  【摘要】 目的：评估伴有面部不对称的小儿先天性颈胸段/上胸段脊柱侧凸畸形行后路半椎体切除矫形术后的临床疗效，观察患儿术后面部不对称的自然转归。方法：2010年6月～2019年1月在我院行一期后路半椎体切除矫形内固定手术的伴有面部不对称的先天性颈胸段/上胸段侧凸畸形患者共16例，其中男性7例，女性9例，年龄5~14岁（8.1±3.2岁）。于术前、术后、末次随访时的站立位全脊柱正侧位X线片上测量局部冠状面侧凸角、局部后凸角、锁骨角、T1倾斜角、颈部倾斜、头部偏斜等参数；术前及末次随访时的颅骨正位X线片标记眶外侧点、颧弓点、上颌点、下颌点、颏结节，术前及末次随访时面部正面像照片标记眼裂外眦点、软组织颧弓点、软组织鼻尖点、软组织下颌角点、软组织颏结节点，分别测量两侧以上各标志点距离面中线的距离，计算非对称率。采用配对t检验比较术前和末次随访时的非对称率。结果：16例患者固定节段为5~10个（7.8±1.2个），术后随访24~49个月（33.3±8.7个月）。术后患者局部侧凸角、局部后凸角、T1倾斜角、锁骨角、颈部倾斜以及头部偏斜均得到显著性改善（P＜0.05）。头颅正位X线片上上颌点、下颌点、颏结节术前非对称率分别为（6.12±1.13）%、（8.73±5.53）%、（25.80±10.41）%，术后末次随访时分别为（4.30±0.66）%、（1.32±0.35）%、（5.52±1.38）%，均得到了显著性改善（P＜0.05）；眶外侧点和颧弓点非对称率术前及末次随访时均＜5%，位于正常范围内。面部正面像照片上颧弓点、下颌角点、颏结节点术前非对称率分别为（10.41±4.38）%、（16.63±5.32）%、（46.82±13.30）%，术后末次随访时分别为（2.18±0.91）%、（4.38±3.83）%、（8.72±4.41）%，差异均有显著性（P＜0.05）。眼裂外眦点非对称率为（3.83±0.96）%，术后末次随访时为（2.26±0.38）%，均在正常范围。结论：小儿先天性颈胸段/上胸段侧凸畸形行后路半椎体切除矫形手术可改善局部侧凸畸形、恢复头-颈-肩平衡，进而在患儿随访过程中其面部不对称性可获得改善。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical outcomes of posterior-only hemivertebra resection in patients with congenital cervicothoracic/upper thoracic scoliosis and facial asymmetry, and to analyze the improvement of facial symmetry during follow-up. Methods: Patients with congenital cervicothoracic/upper thoracic scoliosis, who received posterior-only hemivertebra resection and correction operation in our hospital from June 2010 to January 2019 were retrospectively analyzed. A total of 16 patients(7 males and 9 females) with an average age of 8.1±3.2 years were enrolled in this study. The radiographic parameters including local scoliosis, local kyphosis, clavicle angle, T1 tilt, neck tilt, and head shift were assessed preoperatively, postoperatively and at the last follow-up. The bone markers including laterosuperiot point, zygomatic point, maxillary point, gonion point and mental tubercles were marked on posterior-anterior cephalgram preoperatively and at the last follow-up. The facial soft tissue marker involving the outer canthus point, zygomatic point, gonion point and mental tubercles were marked on anterior facial images preoperatively and at the last follow-up. The asymmetry ratio between the distance planes on both sides to the midline of the above marker points was measured respectively. The paired t test was used for comparative analysis between groups. Results: The mean postoperative follow-up period was 33.3±8.7 months(range, 24－49 months), and the mean fusion levels were 7.8±1.2 levels(range, 5－10 levels). The local scoliosis, local kyphosis, T1 tilt, clavicle angle, neck tilt and head shift were significantly improved after operation(P<0.05 for all). The preoperative asymmetry rates of bone markers of maxillary point, gonion point and mental tubercles were (6.12±1.13)%, (8.73±5.53)% and (25.80±10.41)%, respectively, which were (4.30±0.66)%, (1.32±0.35)% and (5.52±1.38)% at the last follow-up(P<0.05). The bone markers of laterosuperiot point and zygomatic point were both ＜5% preoperatively and at the last follow-up, which were within the normal range. The asymmetry rates of soft tissue of zygomatic point, gonion point and mental tubercles were (10.41±4.38)%, (16.63±5.32)% and (46.82±13.3)% at preoperation, and (2.18±0.91)%, (4.38±3.83)% and (8.72±4.41)% at the last follow-up(P<0.05). The facial soft tissue marker of outer canthus point was (3.83±0.96)% preoperatively and (2.26±0.38)% at the last follow-up, which were within the normal range. Conclusions: For children with congenital cervicothoracic/upper thoracic scoliosis, posterior hemivertebra resection and correction surgery can correct the local scoliosis, and restore head-neck-shoulder balance. Spontaneous improvement of facial asymmetry can also be observed during longitudinal follow-up.