Li Hao,Zhang Xuejun,Qi Xinyu,et al.Efficacy of ultrasonic bone curette assisted osteotomy for pediatric hemivertebral deformity[J].Journal of Clinical Pediatric Surgery,2019,18(05):381-386.[doi:10.3969/j.issn.1671-6353.2019.05.009]
应用超声骨刀辅助截骨矫形治疗儿童半椎体畸形的疗效分析
- Title:
- Efficacy of ultrasonic bone curette assisted osteotomy for pediatric hemivertebral deformity
- 分类号:
- R726.8;R682.3;R687.3+1
- 摘要:
- 目的 初步评估应用超声骨刀（ultrasonic bone curette，UBC）辅助截骨矫形治疗儿童先天性脊柱半椎体畸形的疗效。方法 回顾性分析2015年3月至2017年10月于首都医科大学附属北京儿童医院接受手术治疗的单发半椎体畸形患儿资料。为控制信息偏倚，选择由同一术者完成手术的病例，符合标准的病例根据术中是否应用UBC切除半椎体分为UBC组和非UBC组，其中UBC组24例，男14例，女10例，年龄23~67个月（平均36.0±7.7个月）；非UBC组22例，男13例，女9例，年龄22~68个月（平均40.2±8.2个月）。记录手术时间（min）、手术前后侧凸Cobb角（°）、手术前后红细胞计数（1012/L）及血红蛋白（g/L），并统计胸膜、神经根、硬膜、脊髓损伤情况，计算术后红细胞计数下降率、术后血红蛋白下降率、脊柱侧凸矫正率。结果 UBC组与非UBC组相比，手术时间无统计学差异（t=1.301，P>0.05），UBC组术后红细胞下降率明显低于非UBC组（t=2.279，P<0.05），UBC组术后血红蛋白下降率显著低于非UBC组（t=2.367，P<0.05），两组脊柱侧凸矫正率无统计学差异（t=0.569，P>0.05）。两组各出现1例胸膜损伤，均未出现神经根、脊髓及硬膜损伤。结论 在治疗儿童先天性半椎体畸形方面，应用超声骨刀截骨与传统截骨方法在矫正效果、手术时间与并发症方面无明显差异，但术中出血量相对更少。
- Abstract:
- Objective To explore the efficacy of ultrasonic bone curette (UBC) assisted osteotomy for congenital spinal hemivertebral deformity in children.Methods The clinical and imaging data were analyzed retrospectively for surgical children with single hemivertebral deformities from March 2015 to October 2017.The same operator recorded the pre and post-operative values of operative duration (min),scoliosis Cobb’s angle (DEG),red blood cell count and hemoglobin.Then the postoperative drop rates of red blood cell count and hemoglobin and correction rate of scoliosis were calculated.And the intraoperative injury extents of pleura,nerve root,dura and spinal cord were recorded.The eligible cases were divided into UBC (n=24) and non-UBC (n=22) groups based upon the intraoperative application of UBC or not.There were 14 boys and 10 girls with an average age of (36.0±7.7) (23-67) months in UBC group versus 13 boys and 9 girls with an average age of (40.2±8.2)(22-68) months in non-UBC group.Results No significant inter-group difference in operative duration (t=1.301,P>0.05).The drop rate of red blood cell count decreased significantly lower in group UBC than that in non-UBC group (t=2.279,P<0.05).And the drop rate of hemoglobin decreased significantly lower in UBC group than that in non-UBC group (t=2.367,P<0.05).No significant inter-group difference existed in correction rate of scoliosis (t=0.569,P>0.05).One case of pleural injury was present in each group.There was no occurrence of nerve root,spinal cord or epidural injury.Conclusion For children with congenital hemivertebrae deformity,no significant difference exists in corrective efficacy,operative duration and postoperative complications between UBC versus traditional osteotomy.However,there is less hemorrhage during UBC osteotomy.
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备注/Memo
收稿日期:2018-02-26。
基金项目:国家重点研发计划（编号：2016YFC1000806）
通讯作者:张学军,zhang-x-j04@163.com