临床小儿外科杂志
臨床小兒外科雜誌
림상소인외과잡지
JOURNAL OF CLINICAL FEDIATRIC SURGERY
2015年
3期
168-172
,共5页
郭建伟%仉建国%王升儒%张延斌%杨阳
郭建偉%仉建國%王升儒%張延斌%楊暘
곽건위%장건국%왕승유%장연빈%양양
脊柱/畸形%外科手术%治疗结果
脊柱/畸形%外科手術%治療結果
척주/기형%외과수술%치료결과
Spine /AB%Surgical Procedures,Operative%Treatment Outcome
目的：探讨后路半椎体切除术治疗5岁以下与5～10岁单个半椎体所致先天性脊柱侧凸的临床疗效。方法回顾性分析2003年1月至2012年1月在本院接受手术治疗的60例10岁以下单发半椎体所致先天性脊柱侧凸患儿临床资料，其中男37例，女23例，根据年龄将患儿分为两组：婴幼儿组（≤5岁）35例，儿童组（6～10岁）25例。两组均采用后路半椎体切除、椎弓根螺钉固定及植骨融合术。通过复习病历及术前、术后及末次随访时全脊柱正侧位 X 光片，记录手术时间、融合节段、出血量、术前、术后及末次随访冠状面节段性 Cobb 角、术前、术后及末次随访矢状面节段性后凸角。结果患儿术后均获得规律随访，随访时间：婴幼儿组平均65．0（29～127）个月，儿童组平均80．3（32～148）个月，差异无统计学意义（P ＞0．05）。平均出血量：婴幼儿组285．8（100～700）mL，儿童组512．6（80～1400）mL。融合节段数：婴幼儿组平均3．3（2～7）个，儿童组平均4．9（2～11）个。术前冠状面节段性侧凸 Cobb 角：婴幼儿组平均37．9°（21°～71°），儿童组平均45．8°（25°～94°）。不同年龄组间术中出血量、融合节段数、术前冠状面节段性 Cobb 角比较，差异有统计学意义（P ＜0．05）。术前、术后及末次随访矢状面后凸角、术后及末次随访冠状面 Cobb 角、术前及术后冠状面及矢状面畸形率比较，差异均无统计学意义（P ＞0．05）。婴幼儿组采用短节段融合比例与儿童组比较，差异有统计学意义（57．1％ vs 28％，P ＜0．05）。婴幼儿组有2例围手术期及随访过程中发生并发症（椎弓根骨折1例，术后畸形失代偿行翻修术1例），儿童组有1例出现伤口脂肪液化，两组并发症的发生率比较无统计学意义（5．7％ vs 4．0％，P ＞0．05）。结论后路半椎体切除术是治疗完全分节的半椎体所致先天性脊柱侧凸安全、有效的手术方式，可取得满意的术后及随访效果。但与婴幼儿组相比，儿童组畸形重，术中需要融合的节段更多，创伤更大；建议对于具有生长潜力的非嵌合型半椎体畸形，应在患儿能耐受手术的情况下尽早手术治疗。
目的：探討後路半椎體切除術治療5歲以下與5～10歲單箇半椎體所緻先天性脊柱側凸的臨床療效。方法迴顧性分析2003年1月至2012年1月在本院接受手術治療的60例10歲以下單髮半椎體所緻先天性脊柱側凸患兒臨床資料，其中男37例，女23例，根據年齡將患兒分為兩組：嬰幼兒組（≤5歲）35例，兒童組（6～10歲）25例。兩組均採用後路半椎體切除、椎弓根螺釘固定及植骨融閤術。通過複習病歷及術前、術後及末次隨訪時全脊柱正側位 X 光片，記錄手術時間、融閤節段、齣血量、術前、術後及末次隨訪冠狀麵節段性 Cobb 角、術前、術後及末次隨訪矢狀麵節段性後凸角。結果患兒術後均穫得規律隨訪，隨訪時間：嬰幼兒組平均65．0（29～127）箇月，兒童組平均80．3（32～148）箇月，差異無統計學意義（P ＞0．05）。平均齣血量：嬰幼兒組285．8（100～700）mL，兒童組512．6（80～1400）mL。融閤節段數：嬰幼兒組平均3．3（2～7）箇，兒童組平均4．9（2～11）箇。術前冠狀麵節段性側凸 Cobb 角：嬰幼兒組平均37．9°（21°～71°），兒童組平均45．8°（25°～94°）。不同年齡組間術中齣血量、融閤節段數、術前冠狀麵節段性 Cobb 角比較，差異有統計學意義（P ＜0．05）。術前、術後及末次隨訪矢狀麵後凸角、術後及末次隨訪冠狀麵 Cobb 角、術前及術後冠狀麵及矢狀麵畸形率比較，差異均無統計學意義（P ＞0．05）。嬰幼兒組採用短節段融閤比例與兒童組比較，差異有統計學意義（57．1％ vs 28％，P ＜0．05）。嬰幼兒組有2例圍手術期及隨訪過程中髮生併髮癥（椎弓根骨摺1例，術後畸形失代償行翻脩術1例），兒童組有1例齣現傷口脂肪液化，兩組併髮癥的髮生率比較無統計學意義（5．7％ vs 4．0％，P ＞0．05）。結論後路半椎體切除術是治療完全分節的半椎體所緻先天性脊柱側凸安全、有效的手術方式，可取得滿意的術後及隨訪效果。但與嬰幼兒組相比，兒童組畸形重，術中需要融閤的節段更多，創傷更大；建議對于具有生長潛力的非嵌閤型半椎體畸形，應在患兒能耐受手術的情況下儘早手術治療。
목적：탐토후로반추체절제술치료5세이하여5～10세단개반추체소치선천성척주측철적림상료효。방법회고성분석2003년1월지2012년1월재본원접수수술치료적60례10세이하단발반추체소치선천성척주측철환인림상자료，기중남37례，녀23례，근거년령장환인분위량조：영유인조（≤5세）35례，인동조（6～10세）25례。량조균채용후로반추체절제、추궁근라정고정급식골융합술。통과복습병력급술전、술후급말차수방시전척주정측위 X 광편，기록수술시간、융합절단、출혈량、술전、술후급말차수방관상면절단성 Cobb 각、술전、술후급말차수방시상면절단성후철각。결과환인술후균획득규률수방，수방시간：영유인조평균65．0（29～127）개월，인동조평균80．3（32～148）개월，차이무통계학의의（P ＞0．05）。평균출혈량：영유인조285．8（100～700）mL，인동조512．6（80～1400）mL。융합절단수：영유인조평균3．3（2～7）개，인동조평균4．9（2～11）개。술전관상면절단성측철 Cobb 각：영유인조평균37．9°（21°～71°），인동조평균45．8°（25°～94°）。불동년령조간술중출혈량、융합절단수、술전관상면절단성 Cobb 각비교，차이유통계학의의（P ＜0．05）。술전、술후급말차수방시상면후철각、술후급말차수방관상면 Cobb 각、술전급술후관상면급시상면기형솔비교，차이균무통계학의의（P ＞0．05）。영유인조채용단절단융합비례여인동조비교，차이유통계학의의（57．1％ vs 28％，P ＜0．05）。영유인조유2례위수술기급수방과정중발생병발증（추궁근골절1례，술후기형실대상행번수술1례），인동조유1례출현상구지방액화，량조병발증적발생솔비교무통계학의의（5．7％ vs 4．0％，P ＞0．05）。결론후로반추체절제술시치료완전분절적반추체소치선천성척주측철안전、유효적수술방식，가취득만의적술후급수방효과。단여영유인조상비，인동조기형중，술중수요융합적절단경다，창상경대；건의대우구유생장잠력적비감합형반추체기형，응재환인능내수수술적정황하진조수술치료。
Objetive To evaluate the efficacy of posterior hemivertebra resection with transpedicular in-strumentation in different age groups.Methods From January 2003 to January 2012,60 consecutive cases of congenital scoliosis with single hemivertebra were retrospectively investigated,including 37 females and 23 males.All the cases were divided into EOS(early onset scoliosis,≤5 years old)group and Children group (>5 years old).All patients were treated with posterior hemivertebra resection with transpedicular instrumenta-tion.The medical records were reviewed and long cassette radiographs of spine were measured preoperatively, postoperatively and at last follow-up to record the corrections and complications. Results All the cases were under regular follow-up after operation and the mean follow-up was 65.0 (29 ~127)months in EOS group and 80.3 (32 ~148)months in Children group,which showed statistical differences.The average blood loss was 285.8 (100 ~700)ml in EOS group,and 512.6 (80 ~1400)ml in Children group.The average fused seg-ments were 3.3 in EOS group and 4.9 (2 ~11)in Children group,including monosegmental fusion of two ad-jacent vertebra in 20 cases (57.1%)in EOS group and 7 cases (28%)in Children group.The pre-operative segmental scoliosis was 37.9°(21°~71°)in EOS group and 45.8°(25°~94°)in Children group.There were significant statistical differences in blood loss,fused segments,rates of monosegmental fusion and pre-op-erative scoliosis between EOS group and Children group.No significant statistical differences were found in cor-rections on coronal and sagittal planes between EOS group and Children group.There were 2 complications in 2 cases in EOS group (1 pedicle fracture,1 curve progression)and 1 complication (wound union)in 1 case in Children group,which showed no significant differences (5.7% vs 4.0%,P >0.05).There was no neurologi-cal complication.2 cases in EOS group and 1 case in Children group underwent implant removal because of progressive pedicle elongation during the follow-up. Conclusions Posterior hemivertebra resection with trans-pedicular instrumentation is a safe and effective procedure,which can achieve good correction and save more mobile segments.However,the older the cases are,the more serious the deformity is and the more segment needed to be fused.It should be performed in the early period of the patients with fully-segmented non-incar-cerated hemivertebra.
