儿童颈椎后凸畸形的手术疗效分析

Surgical treatment of cervical kyphosis in children

中文关键词:  颈椎后凸  儿童  手术治疗  疗效

英文关键词:Cervical kyphosis  Children  Surgical treatment  Curative effect

中文摘要:

  【摘要】 目的：探讨和分析手术治疗儿童颈椎后凸畸形的术式和疗效。方法：回顾性分析 2014年1月～2018年1月北京儿童医院收治的9例儿童颈椎后凸畸形患者的临床资料，其中男5例，女4例；年龄11个月～14岁（5.32±4.48岁）。颈椎后凸病因：神经纤维瘤病2例，先天性4例，医源性1例，结核性1例，成骨不全1例。8例术前有颈部疼痛，5例合并神经功能损伤（ASIA分级C级2例，D级3例）。2例伴颈椎脱位，2例伴脊柱侧凸畸形。术前采用Halo头环牵引2例，颅骨牵引1例，悬吊牵引1例，平衡悬吊牵引2例。5例单纯行前路矫形手术（神经纤维瘤病2例，先天性1例，医源性1例，成骨不全1例）；4例行前后路联合手术（先天性3例，结核性1例），其中一、二期（松解后牵引）各2例。记录术中和术后并发症，在术前、术后和末次随访时的颈椎侧位X线片上测量后凸节段Cobb角，计算矫形率。结果：患者均顺利完成手术，术中无神经、血管及脏器损伤并发症。单纯前路手术患者后凸Cobb角度由术前45°～85°（72°±16°）矫正至术后0°～30°（12.6°±14.1°），矫正率63%～100%[（83±19）%]；前后路联合手术患者后凸Cobb角由术前40°～85°（55°±20°）矫正至术后0°～30°（16.3°±12.5°），矫正率33%～100%[（64±28）%]。随访3～6年（4±1年），融合节段均在术后3个月实现骨性融合，末次随访时矫正率无丢失，无内固定失效。4例患儿末次随访出现邻近节段退变，3例患儿出现远端交界性后凸。末次随访时，神经功能均为E级。结论：根据病因及患者个体情况选择合适的手术方式治疗儿童颈椎后凸畸可取得较好的矫形效果，由于儿童生长发育的不确定性，远期发生邻近节段退变和远期交界性后凸的风险不容忽视。

英文摘要:

  【Abstract】 Objectives: To explore the method and curative effect of surgical treatment of cervical kyphosis in children. Methods: 9 patients with cervical kyphosis treated surgically in Beijing Children′s Hospital from January 2014 to January 2018 were analyzed retrospectively. There were 5 males and 4 females, with an average age of 5.32±4.48 years ranging from 11 months to 14 years. The etiologies included: neurofibromatosis (2 patients), congenital malformation(4 patients), iatrogenic malformation(1 patients), tuberculousis malformation (1 patient), and osteogenesis imperfect(1 patient). Neck pain was noted in 8, neurological impairment in 5(ASIA grade: 2 cases of grade C and 3 of grade D), cervical dislocation in 2, and scoliosis in 2. Corrective surgery through anterior approach was performed in 5 cases, and combined anterior-posterior approach in 4 patients, with 2 cases in one-stage and 2 cases in two-stage(traction after release). Halo traction was carried out preoperatively in 2 cases, skull traction in 1 case, suspension traction in 1 case, and balanced suspension traction in 2 cases. The change of kyphosis curvature was measured by Cobb angle. Parameters including kyphosis levels, the apex of the curvature, the Cobb angle were measured on lateral radiographs of neutral position of each patient. The preoperative and postoperative changes of various parameters were compared. The correction rate was calculated and evaluated. Results: All patients underwent the operation successfully without complications of nerve, blood vessel and organ injury. For single anterior approach group, the average Cobb angle was 45°-85°(72°±16°) preoperation and corrected to 0°-30°(12.6°±14.1°) postoperation with a correction ratio of 63%-100%[(83±19)%]. In the group of combined anterior-posterior approach surgery, the average Cobb angle was 40°-85°(55°±20°) before surgery and 0°-30°(16.3°±12.5°) after surgery with a correction ratio of 33%-100%[(64±28)%]. All patients were followed up for 3-6 years(4±1 years), and bony fusion was achieved at 3 months after operation for all the fusion segments. There were no loss of correction and failure of internal fixation, 4 cases had adjacent segment degeneration and 3 cases had junctional kyphosis. At the last follow-up, nervous function had recovered to grade E. Conclusions: The appropriate surgical strategy customized for the individual conditions of different etiology and pathology can achieve good results in the treatment of cervical kyphosis for children. In the long run, there may be a relative higher risk of adjacent segment degeneration and distal junctional kyphosis in this immature population.