Feng Lei,Zhang Xuejun,Guo Dong,et al.Analysis of surgical efficacy for spinal vertebral damage in children with Langerhans cell histiocytosis[J].Journal of Clinical Pediatric Surgery,,20():761-765,772.[doi:10.12260/lcxewkzz.2021.08.011]
Analysis of surgical efficacy for spinal vertebral damage in children with Langerhans cell histiocytosis
- CLC:
- R730.262.4;R687.37;R651.21
- Abstract:
- Objective To explore the efficacy for spinal vertebral damage in children with Langerhans cell histiocytosis (LCH). Methods Retrospective analysis was conducted for 67 hospitalized LCH cases with vertebral destruction from January 2015 to January 2019. Posterior fixation and pathological biopsy were performed. During operation, somatosensory evoked potential (SEP) and motor evoked potential (MEP) were monitored simultaneously. Alterations of SEP amplitude decreasing >50% or latent period extending by 10% or MEP wave amplitude decreasing >80% were diagnosed as positive changes. Any type of myoelectric response hinting at provocation of nerve root was also interpreted as a positive change. Anteroposterior and lateral radiographs and computed tomography (CT) was employed for measuring sagittal kyphosis angle and vertebral height in vertebral lesions pre-operation and at the final follow-up. Perioperative neurological functions were evaluated by the scale of American Spinal Injury Association (ASIA). Results There were 22 boys and 45 girls with an average age of (4.4±2.6) years. The postoperative follow-up period was over 2 years. The segmental kyphosis angle declined post-operation (30.1±10.1 vs. 5.9±5.1). Significant differences existed in kyphosis angle between preoperative timepoints and the final follow-up (t=8.891, P<0.001). The mean vertebral height in lesion was significantly higher at the final follow-up than pre-operation (5.9±4.0 vs. 13.9±7.2 mm, t=7.443, P<0.001). And 53 of them were free of preoperative neurological symptoms with an ASIA grade of E while the remainders had reduced muscle strength of lower limbs with an ASIA grade of C/D. The results of neurological examination immediately post-operation were the same as those pre-operation. All children had an ASIA grade of E at the last follow-up. Success rate of SEP recording was 100% and MEP 85.1%. Elicitation of MEP failed (n=10, 14.9%). Conclusion For children with severe vertebral damage, especially those with preoperative neurological symptoms, surgery can not only elucidate the pathology, but also restore vertebral height, restore spinal stability and promote the recovery of damaged nerves
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Memo
收稿日期:2021-07-06。
通讯作者:张学军,Email:zhang-x-j04@163.com