CAJ | 학술논문

目的：探讨 CD 三维矫形系统在矫正低龄儿童半椎体所致脊柱畸形中的应用方法、意义、并发症的处理及术后处理。方法2011年7月至2014年6月我们应用 CD 系统矫治低龄儿童半椎体所致脊柱侧后凸畸形27例，其中单纯性半椎体合并脊柱侧凸12例，半椎体合并脊柱侧、后凸15例。27例中，合并蝴蝶椎等复杂分节不良畸形6例，合并单侧肾脏缺如1例。术前冠状面侧凸 Cobb 角24°～45°，平均32°；矢状面脊柱后凸 Cobb 法0°～21°，平均15．5°，旋转畸形为Ⅰ～Ⅲ度。年龄1岁10个月至5岁8个月。手术均采用后路融合，固定点为需切除的病变椎上下椎体，若遇上下椎体有畸形不宜植钉，则适当上或下移一椎体。先固定凹侧，楔形切除半椎体附件及椎体，凸侧加压，钉棒系统固定。结果所有患儿术后经1～36个月（平均16个月）随访，冠状面畸形为5°～15°，平均11．5°，平均矫正率为64．1％；矢状面胸椎后凸0°～10°，平均6°，旋转畸形矫正。1例出现断钉1枚，但无症状及矫正丢失。无一例术后出现截瘫，无断棒及钉拔出等并发症。10例术后出现不同程度腹胀、腹痛现象，经对症处理后3～7 d 内明显缓解或消失。无一例出现伤口感染。15例术后出现10°以上代偿性侧弯，支具矫正后逐渐重新建立躯干平衡。结论后入路切除半椎体，畸形外观改善明显，脊柱侧后凸程度明显减轻，但要彻底切除半椎体上下生长板，减少凸侧生长点，防止复发；同时切除对侧附件，达到楔形截骨的效果，才能使矫形无张力，不易出现“拔钉”现象。
목적：탐토 CD 삼유교형계통재교정저령인동반추체소치척주기형중적응용방법、의의、병발증적처리급술후처리。방법2011년7월지2014년6월아문응용 CD 계통교치저령인동반추체소치척주측후철기형27례，기중단순성반추체합병척주측철12례，반추체합병척주측、후철15례。27례중，합병호접추등복잡분절불량기형6례，합병단측신장결여1례。술전관상면측철 Cobb 각24°～45°，평균32°；시상면척주후철 Cobb 법0°～21°，평균15．5°，선전기형위Ⅰ～Ⅲ도。년령1세10개월지5세8개월。수술균채용후로융합，고정점위수절제적병변추상하추체，약우상하추체유기형불의식정，칙괄당상혹하이일추체。선고정요측，설형절제반추체부건급추체，철측가압，정봉계통고정。결과소유환인술후경1～36개월（평균16개월）수방，관상면기형위5°～15°，평균11．5°，평균교정솔위64．1％；시상면흉추후철0°～10°，평균6°，선전기형교정。1례출현단정1매，단무증상급교정주실。무일례술후출현절탄，무단봉급정발출등병발증。10례술후출현불동정도복창、복통현상，경대증처리후3～7 d 내명현완해혹소실。무일례출현상구감염。15례술후출현10°이상대상성측만，지구교정후축점중신건립구간평형。결론후입로절제반추체，기형외관개선명현，척주측후철정도명현감경，단요철저절제반추체상하생장판，감소철측생장점，방지복발；동시절제대측부건，체도설형절골적효과，재능사교형무장력，불역출현“발정”현상。
Objetive To study the surgical method,clinical significance,management of complications and postoperative treatment of edge-shaped resection the hemivertebra from the back by the first stage in young children using the CD three-dimensional orthopedic system. Methods From July 2011 to June 2014,We a-dopted CD three-dimensional orthopedic system to correct 27 cases congenital kyphoscoliosis caused by hemi-vertebra deformities.There were 12 cases combination of scoliosis and hemivertebra.There were 15 cases com-bination of kyphoscoliosis and hemivertebra.There were 6 cases complex combination of butterfly vertebrae and vertebral segmentation defects.There was 1 case combined with Kidney deficiency.The lateral convex Cobb Angle was 24°to 45°from,an average of 32°,the sagittal convex Cobb Angle was 0°to 21°,on average of 15.5°,rotational deformity was Ⅰ ~Ⅲ degrees.The age ranged from 1 year 10 months to 5 years 8 months. All the patients adopted posterior fusion,the up and down vertebral body were fixed.If there was lesion of the vertebral body the upper or the downer were fixed.The concave side was fixed firstly,Wedge-shaped resection the hemivertebra were performed,vertebral body accessories and vertebral body were totally removed and then the convex side was fixed.Results After 1 ~36 months following up(16 months on average),The lateral con-vex Cobb Angle was 5°to 15°from,on average was 11.5°,the average correct rate was 64.1%.The sagittal convex Cobb Angle was 0°to 10°,an average of 6°,rotational deformity was totally corrected.One pin was broken in one patient,but it had no symptoms and correction loss.There was no complications such as paraple-gia,rod broken,or pin pulled out.10 cases had the phenomenon of abdominal distension and abdominal pain, but they all relieved when they were symptomatic treated for 3 ~7 days.There was no wound infection.15 pa-tients had the compensatory side-bending at least 10 degrees,then they were treated by the braces and they were gradually established balance again after operation. Conclusions The surgery results showed that resec-tion of the hemivertebra could get the appearance.The kyphoscoliosis could be relieved.The growth plate of the hemivertebra should be totally removed in case of recurrence.The opposite vertebral body attachment should also be eradicated,thus there is no tension when they were fixed,and the pin is hardly be pulled out af-ter surgery.