Li Chenkai,Wang Shengru,Zhang Jianguo,et al.Surgery for lower cervical/cervicothoracic congenital spinal deformities in children aged under 10 years:clinical outcomes and complications[J].Journal of Clinical Pediatric Surgery,,22():1008-1014.[doi:10.3760/cma.j.cn101785-202307025-002]
Surgery for lower cervical/cervicothoracic congenital spinal deformities in children aged under 10 years:clinical outcomes and complications
- Keywords:
- Cervical Vertebrae; Spine; Congenital Abnormalities; Surgical Procedures; Operative; Child
- Abstract:
- Objective To evaluate the clinical outcomes and complications of surgery for lower cervical/cervicothoracic congenital spinal deformities in children.Methods A total of 19 children with lower cervical/cervicothoracic congenital spinal deformity were hospitalized from April 2011 to March 2023.Observation parameters included demographics,surgical related parameters and radiological parameters.Surgical related parameters included surgical approach,operative duration,hemorrhagic volume,autologous blood transfusion,blood transfusion volume,neurological monitoring,fusion level and osteotomy level/mode.The radiological parameters included Cobb angle of major curvature,Cobb angle of distal compensatory curve,T1 tilt,clavicular angle,torticollis,segmental kyphosis,thoracic kyphosis and sagittal vertical axis.Perioperative complications were also recorded.Results Operative duration was (296.2±98.7)(180-550) min and intraoperative hemorrhagic volume (328.9±170.4)(150-800) mL.Preoperative Cobb angle of major curvature was 33.0(22.8,45.6)° and immediately post-operation 3.4(1.8,11.3)°.At the last follow-up,Cobb angle of major curvature improved to 5.7(2.0,14.0)°.Preoperative T1 tilt angle was 15.1(9.9,23.8)° and 6.0(3.3,11.9)°and 6.8(4.0,16.6)°at immediate post-operation and the final follow-up.Preoperative clavicle angle was (5.7±3.2)° and immediate and final follow-up clavicle angles (3.0±2.7)° and (2.4±2.0)°.Preoperative torticollis angle was (16.9±9.7)° and immediate and final follow-up torticollis angles (6.6±6.2)° and (8.1±3.7)°.Preoperative segmental kyphosis angle was (53.0±13.0)° and immediate and final follow-up segmental kyphosis angles (17.2±11.1)° and (16.3±8.8)°.As compared with pre-operation,Cobb angle of major curvature,T1 tilt,clavicle angle,torticollis and segmental kyphosis significantly improved at immediate post-operation or the last follow-up (P<0.05).Fifteen patients (78.9%) developed 19 complications,including transient nerve root injury (n=13,68.4%),Horner syndrome (n=1,5.3%),unilateral C8 nerve root injury (n=1,5.3%),implant failure (n=2,10.4%),cerebrospinal fluid leakage (n=1,5.3%) and pleural effusion (n=1,5.3%).Conclusions As a major treatment for lower cervical/ cervicothoracic congenital scoliosis in children,surgery may achieve an ideal correction.However,the incidence of surgical related neurological complications remains high and surgeons should pay greater attention to it.
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Memo
收稿日期:2023-7-16。
基金项目:国家自然科学基金(82172382,81972037); 北京市自然科学基金(7222133,L222096)
通讯作者:王升儒,Email:wangshengru@foxmail.com; 仉建国,Email:jgzhang_pumch@yahoo.com