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,2023,22(11):1008-1014.[doi:10.3760/cma.j.cn101785-202307025-002]
10岁以下儿童下颈椎/颈胸段先天性脊柱畸形手术疗效与并发症分析
- Title:
- 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
- 摘要:
- 目的 初步评估儿童下颈椎/颈胸段先天性脊柱畸形手术的疗效和并发症。方法 回顾性分析2011年4月至2023年3月北京协和医院骨科收治的19例下颈椎/颈胸段先天性脊柱畸形患儿临床资料。观察指标包括患儿一般情况、手术相关指标及影像学测量指标。手术相关指标包括手术入路、手术时间、出血量、自体血回输、输血量、脊髓监测报警情况、固定节段、截骨水平及方式;影像学测量指标包括主弯Cobb角、远端代偿弯Cobb角、第1胸椎倾斜角、锁骨角、斜颈、节段性后凸、胸后凸和脊柱矢状面平衡。同时记录术中、术后并发症发生情况。结果 19例下颈椎或颈胸段先天性脊柱畸形患儿手术时间为(296.2±98.7)min(180~550min),术中出血量为(328.9±170.4)mL(150~800mL)。术前主弯Cobb角为33.0 (22.8,45.6)°,术后即刻为3.4 (1.8,11.3)°,末次随访时主弯Cobb角改善至5.7 (2.0,14.0)°;术前第1胸椎倾斜角为15.1 (9.9,23.8)°,术后即刻和末次随访时第1胸椎倾斜角分别为6.0 (3.3,11.9)°、6.8 (4.0,16.6)°;术前锁骨角为(5.7±3.2)°,术后即刻和末次随访时锁骨角分别为(3.0±2.7)°、(2.4±2.0)°;术前斜颈角度为(16.9±9.7)°,术后即刻和末次随访时斜颈角度分别为(6.6±6.2)°、(8.1±3.7)°;术前节段性后凸角度为(53.0±13.0)°,术后即刻和末次随访时节段性后凸角度分别为(17.2±11.1)°、(16.3±8.8)°;术后即刻、末次随访结果与术前相比,上述指标差异均具有统计学意义(P＜0.05)。19例中,共15例发生19例次并发症,包括一过性神经根损伤13例次、Horner综合征1例次、一侧第8颈椎神经根损伤1例次、内固定失败2例次、脑脊液漏1例次以及胸腔积液1例次。结论 手术是儿童下颈椎/颈胸段先天性脊柱侧凸的主要治疗方式,可获得良好的矫形效果,但手术相关神经系统并发症的发生率较高,外科医师应予以重视。
- 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.
参考文献/References:
[1] Simon S,Davis M,Odhner D,et al.CT imaging techniques for describing motions of the cervicothoracic junction and cervical spine during flexion,extension,and cervical traction[J].Spine (Phila Pa 1976),2006,31(1):44-50.DOI:10.1097/01.brs.0000192679.25878.f9.
[2] Johal J,Loukas M,Fisahn C,et al.Hemivertebrae:a comprehensive review of embryology,imaging,classification,and management[J].Childs Nerv Syst,2016,32(11):2105-2109.DOI:10.1007/s00381-016-3195-y.
[3] Ruf M,Jensen R,Harms J.Hemivertebra resection in the cervical spine[J].Spine (Phila Pa 1976),2005,30(4):380-385.DOI:10.1097/01.brs.0000153398.78661.2b.
[4] Ferro F,Spinella P,Lama N.Transverse maxillary arch form and mandibular asymmetry in patients with posterior unilateral crossbite[J].Am J Orthod Dentofacial Orthop,2011,140(6):828-838.DOI:10.1016/j.ajodo.2011.08.003.
[5] Dubousset J.Torticollis in children caused by congenital anomalies of the atlas[J].J Bone Joint Surg Am,1986,68(2):178-188.
[6] Thomsen MN,Schneider U,Weber M,et al.Scoliosis and congenital anomalies associated with Klippel-Feil syndrome types Ⅰ-Ⅲ[J].Spine (Phila Pa 1976),1997,22(4):396-401.DOI:10.1097/00007632-199702150-00008.
[7] Frikha R.Klippel-Feil syndrome:a review of the literature[J].Clin Dysmorphol,2020,29(1):35-37.DOI:10.1097/MCD.0000000000000301.
[8] Zhang HQ,Du YX,Liu JY,et al.Strategy and efficacy of surgery for congenital cervicothoracic scoliosis with or without hemivertebra osteotomy[J].Orthop Surg,2022,14(9):2050-2058.DOI:10.1111/os.13480.
[9] Cao S,Chen X,Pan SF,et al.Evaluation and comparation of a novel surgical technique and hemivertebra resection to the correction of congenital cervical scoliosis in lower cervical and cervicothoracic spine[J].Neurospine,2022,19(4):1071-1083.DOI:10.14245/ns.2244554.277.
[10] Marks DS,Qaimkhani SA.The natural history of congenital scoliosis and kyphosis[J].Spine (Phila Pa 1976),2009,34(17):1751-1755.DOI:10.1097/BRS.0b013e3181af1caf.
[11] Chen ZH,Qiu Y,Zhu ZZ,et al.Posterior-only hemivertebra resection for congenital cervicothoracic scoliosis:correcting neck tilt and balancing the shoulders[J].Spine (Phila Pa 1976),2018,43(6):394-401.DOI:10.1097/BRS.0000000000002325.
[12] Smith MD.Congenital scoliosis of the cervical or cervicothoracic spine[J].Orthop Clin North Am,1994,25(2):301-310.DOI:10.1016/S0030-5898(20)31911-8.
[13] Bayoumi AB,Efe IE,Berk S,et al.Posterior rigid instrumentation of C7:surgical considerations and biomechanics at the cervicothoracic junction.A review of the literature[J].World Neurosurg,2018,111:216-226.DOI:10.1016/j.wneu.2017.12.026.
[14] Yu M,Diao YZ,Sun Y,et al.Evaluation of a combined approach to the correction of congenital cervical or cervicothoracic scoliosis[J].Spine J,2019,19(5):803-815.DOI:10.1016/j.spinee.2018.11.006.
[15] Samudrala S,Vaynman S,Thiayananthan T,et al.Cervicothoracic junction kyphosis:surgical reconstruction with pedicle subtraction osteotomy and smith-petersen osteotomy.Presented at the 2009 Joint Spine Section Meeting.Clinical article[J].J Neurosurg Spine,2010,13(6):695-706.DOI:10.3171/2010.5.SPINE08608.
[16] Wang SR,Lin GF,Yang Y,et al.Outcomes of 360° osteotomy in the cervicothoracic spine (C7-T1) for congenital cervicothoracic kyphoscoliosis in children[J].J Bone Joint Surg Am,2019,101(15):1357-1365.DOI:10.2106/JBJS.18.01428.
[17] Zhu F,Sun X,Qiao J,et al.Misplacement pattern of pedicle screws in pediatric patients with spinal deformity:a computed tomography study[J].J Spinal Disord Tech,2014,27(8):431-435.DOI:10.1097/BSD.0b013e31828d6a1b.
[18] Privitera DM,Matsumoto H,Gomez JA,et al.Are breech rates for pedicle screws higher in the upper thoracic spine?[J].Spine Deform,2013,1(3):189-195.DOI:10.1016/j.jspd.2013.04.002.
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备注/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