CAJ | 학술논문

目的探讨环钻在完全分节型半椎体性先天性脊柱侧凸患者经椎弓根切除半椎体手术中的价值。方法回顾性分析2002年7月至2011年7月，在我院行半椎体切除的完全分节型半椎体性先天性脊柱侧凸患儿25例，男8例，女17例，年龄5～14岁，平均9.6岁。9例接受常规的经椎弓根半椎体切除术(A组)，16例采用环钻经椎弓根行半椎体切除术(B组)。记录并比较两组患者的手术时间、出血量，术后侧凸角和后凸角的矫正率及末次随访时丢失率。结果所有患者均获随访，随访时间平均(21±6.2)个月，两组病例的年龄及性别组成相匹配。手术时间A组平均(213±33)min；B组平均(174±26)min，两组比较差异有统计学意义(t＝7.23，P＜0.05)。出血量A组平均(840±118)ml；B组平均(710±73)ml；两组比较差异有统计学意义(t＝4.38，P＜0.05)。侧凸Cobb’s角A组术后即刻矫正率为81.9%，术后1年随访矫正丢失率为4.3%；B组术后即刻矫正率为83.0%，术后1年随访矫正丢失率为3.5%，差异无统计学意义(t＝1.54，P＝0.16；t＝1.35，P＝0.20)。后凸角A组术后即刻矫正率为77.9%，术后1年随访矫正丢失率为7.1%；B组术后即刻矫正率为74.3%，术后1年随访矫正丢失率为5.4%，差异无统计学意义(t＝1.28，P＝0.22；t＝1.12，P＝0.29)。两组患者术中及随访期间均未发生严重神经、血管及内固定物相关并发症。结论经椎弓根行半椎体切除联合内固定矫形是治疗完全分节型半椎体性先天性脊柱侧凸的有效手段，应用环钻在增加手术安全性的前提下可明显缩短手术时间并减少术中出血。
목적탐토배찬재완전분절형반추체성선천성척주측철환자경추궁근절제반추체수술중적개치。방법회고성분석2002년7월지2011년7월，재아원행반추체절제적완전분절형반추체성선천성척주측철환인25례，남8례，녀17례，년령5～14세，평균9.6세。9례접수상규적경추궁근반추체절제술(A조)，16례채용배찬경추궁근행반추체절제술(B조)。기록병비교량조환자적수술시간、출혈량，술후측철각화후철각적교정솔급말차수방시주실솔。결과소유환자균획수방，수방시간평균(21±6.2)개월，량조병례적년령급성별조성상필배。수술시간A조평균(213±33)min；B조평균(174±26)min，량조비교차이유통계학의의(t＝7.23，P＜0.05)。출혈량A조평균(840±118)ml；B조평균(710±73)ml；량조비교차이유통계학의의(t＝4.38，P＜0.05)。측철Cobb’s각A조술후즉각교정솔위81.9%，술후1년수방교정주실솔위4.3%；B조술후즉각교정솔위83.0%，술후1년수방교정주실솔위3.5%，차이무통계학의의(t＝1.54，P＝0.16；t＝1.35，P＝0.20)。후철각A조술후즉각교정솔위77.9%，술후1년수방교정주실솔위7.1%；B조술후즉각교정솔위74.3%，술후1년수방교정주실솔위5.4%，차이무통계학의의(t＝1.28，P＝0.22；t＝1.12，P＝0.29)。량조환자술중급수방기간균미발생엄중신경、혈관급내고정물상관병발증。결론경추궁근행반추체절제연합내고정교형시치료완전분절형반추체성선천성척주측철적유효수단，응용배찬재증가수술안전성적전제하가명현축단수술시간병감소술중출혈。
Objective To explore the value of trephine in the treatment of congenital fully-segmented hemivertebra spinal scoliosis in transpedicular hemivertebra resection. Methods 25 patients with congenital fully-segmented hemivertebra spinal scoliosis were treated by hemivertebra resection in our hospital from July 2002 to July 2011, whose data were retrospectively analyzed. There were 8 males and 17 females, with a mean age of 9.6 years old ( range;5-14 years ). 9 patients received traditional transpedicular hemivertebra resection ( group A ) and 16 patients received transpedicular hemivertebra resection using trephine ( group B ). The operation time, blood loss, postoperative correction rate of the scoliotic angle and kyphotic angle and loss rate in the latest follow-up were recorded and compared between the 2 groups. Results All patients were followed up, and the mean follow-up time was ( 21±6.2 ) months. There were no signiifcant differences in age and sex between the 2 groups. The mean operation time was ( 213±33 ) min in group A and ( 174±26 ) min in group B, and the differences were statistically signiifcant ( t=7.23, P<0.05 ). The mean blood loss was ( 840±118 ) ml in group A and ( 710±73 ) ml in group B, and the differences were statistically signiifcant ( t=4.38, P<0.05 ). The correction rate of scoliosis Cobb’s angle immediately after the operation was 81.9%in group A and 83.0%in group B, and the differences were not statistically signiifcant ( t=1.54, P=0.16 );The loss rate of scoliosis Cobb’s angle in the follow-up 1 year after the operation was 4.3%in group A and 3.5%in group B, and the differences were not statistically signiifcant ( t=1.35, P=0.20 ). The correction rate of kyphotic angle immediately after the operation was 77.9%in group A and 74.3%in group B, and the differences were not statistically signiifcant ( t=1.28, P=0.22 );The loss rate of kyphotic angle in the follow-up 1 year after the operation was 7.1%in group A and 5.4%in group B, the differences were not statistically signiifcant ( t=1.12, P=0.29 ). No severe complications related to nerves, blood vessels or internal ifxation instrumentation occurred in both groups during the operation and follow-up. Conclusions Transpedicular hemivertebra resection combined with internal ifxation is an effective way in treating congenital fully-segmented hemivertebra spinal scoliosis, which can obviously not only shorten the operation time, but also reduce blood loss on the premise of increasing the safety of operation using trephine.