CAJ | 학술논문

目的：比较经后路半椎体切除结合短节段与长节段内固定治疗胸腰段先天性脊柱侧凸的临床疗效。方法回顾分析2004年1月～2011年12月经后路半椎体切除结合椎弓根螺钉固定手术治疗的27例胸腰段先天性半椎体脊柱侧凸患者临床资料，其中11例行短节段固定（半椎体上、下各1个椎体，A组），16例行长节段固定（半椎体上、下各2个椎体，B组）。比较两组手术时间、术中出血量、并发症以及侧凸、后凸Cobb角等指标。结果 A组手术时间及术中出血量显著低于B组（ P＜0.05）。两组术后即刻及末次随访侧凸、后凸Cobb角均较术前显著改善（ P＜0.05）。两组间术后即刻侧凸及后凸Cobb角比较，差异无统计学意义（ P＞0.05）。 B组末次随访时侧凸、后凸Cobb角矫正率均明显高于A组（ P＜0.05），B组末次随访侧凸、后凸Cobb角矫正丢失度明显小于A组（ P＜0.05）。 A组有2例内固定失败，其余患者均无并发症出现，B组并发症发生率明显低于A组。结论采用后路长节段椎弓根螺钉固定治疗胸腰段先天性脊柱侧凸术中失血量及手术时间明显增加，但矫正脊柱侧凸畸形、预防远期侧凸、后凸矫正丢失及防止并发症方面明显优于短节段固定，临床应用应区分适应证。
목적：비교경후로반추체절제결합단절단여장절단내고정치료흉요단선천성척주측철적림상료효。방법회고분석2004년1월～2011년12월경후로반추체절제결합추궁근라정고정수술치료적27례흉요단선천성반추체척주측철환자림상자료，기중11례행단절단고정（반추체상、하각1개추체，A조），16례행장절단고정（반추체상、하각2개추체，B조）。비교량조수술시간、술중출혈량、병발증이급측철、후철Cobb각등지표。결과 A조수술시간급술중출혈량현저저우B조（ P＜0.05）。량조술후즉각급말차수방측철、후철Cobb각균교술전현저개선（ P＜0.05）。량조간술후즉각측철급후철Cobb각비교，차이무통계학의의（ P＞0.05）。 B조말차수방시측철、후철Cobb각교정솔균명현고우A조（ P＜0.05），B조말차수방측철、후철Cobb각교정주실도명현소우A조（ P＜0.05）。 A조유2례내고정실패，기여환자균무병발증출현，B조병발증발생솔명현저우A조。결론채용후로장절단추궁근라정고정치료흉요단선천성척주측철술중실혈량급수술시간명현증가，단교정척주측철기형、예방원기측철、후철교정주실급방지병발증방면명현우우단절단고정，림상응용응구분괄응증。
Objective To compare the effectiveness of posterior hemivertebra resection with long or short segment internal fixation for the treatment of congenital hemivertebrae deformation in the thoracolumbar .Methods Between January 2004 and December 2011 , 27 patients with congenital hemivertebrae deformation in the thoracolumbar underwent posterior hemivertebra re-section and long or short segment internal fixation .Of 27 patients , 11 received short-segment fixation (1 upper and 1 lower vertebral bodies of the hemivertebrae ) in group A, and 16 re-ceived long-segment fixation ( 2 upper and 2 lower vertebral bodies of the hemivertebrae ) in group B.The operative time,blood loss, complication, scoliotic Cobb angle, kyphotic Cobb angle, rectificatory rate and loss of rectificatory were observed and compared between 2 groups. Results The operative time and blood loss of group B were significantly higher than those of group A ( P<0.05 ) .No complication occurred in other patients except 2 cases had internal fixation failure in group A .The scoliotic Cobb angle and kyphotic Cobb angle were decreased in 2 groups at immediately after operation and last follow-up than before operation ( P<0.05 ) , but no significant difference was found between 2 groups at immediately after operation .The correction rates of Cobb angle at last follow-up in group B were significantly higher than those in group A ( P<0.05 ); whereas the correction loss of Cobb angle and complication in group B were significantly less than those in group A ( P<0.05 ) .Conclusion Long-segment fixation is better than short-segment fixation in the correction of Cobb , especially in the prevention of correction loss in long-term follow-up although it will increase the blood loss and operation time.The clinical application should distinguish indications .