Guo Dong,Gao Rongxuan,Yao Ziming,et al.One-stage posterior-only lumbosacral hemivertebra resection with short-segment internal fixation and fusion in children[J].Journal of Clinical Pediatric Surgery,2020,19(07):596-602.[doi:10.3969/j.issn.1671-6353.2020.07.007]
儿童腰骶部半椎体一期后路切除短节段固定治疗效果分析
- Title:
- One-stage posterior-only lumbosacral hemivertebra resection with short-segment internal fixation and fusion in children
- Keywords:
- Scoliosis/SU; Lumbosacral Region; Treatment Outcome; Child
- 分类号:
- R726.8;R681.5+7
- 摘要:
- 目的 评价儿童先天性腰骶部畸形一期后路半椎体切除、短节段固定治疗的手术效果。方法 回顾性分析2014年1月至2017年12月首都医科大学附属北京儿童医院诊治的21例腰骶部半椎体患儿的临床资料，均行腰骶部一期后路半椎体切除术以及短节段固定融合术，随访至少24个月。术前、术后及末次随访时患儿均行站立位全脊柱正侧位X线检查。对比术前、术后以及末次随访时结构性侧凸、近端代偿弯、胸椎后凸、腰椎前凸的Cobb角、躯干偏移、矢状面平衡以及骨盆入射角、骨盆倾斜角、骶骨倾斜角。结果 21例中男12例，女9例；手术年龄2.17~13.00岁，平均（6.50±3.22）岁；术后随访24~84个月，平均（48.10±17.72）个月；融合固定2~4个椎体，平均（2.67±0.91）个椎体；手术时间120~300 min，平均（168.57±46.18） min；术中出血量100~1 000 mL，平均（368.04±234.58） mL；侧凸Cobb角由术前的（28.9±6.3）°降至术后的（8.5±3.0）°，末次随访时为（7.0±3.4）°，矫正率为75.8%。冠状面近端代偿弯Cobb角由术前（25.8±11.7）°自发性矫正为末次随访时（13.7±8.3）°，矫正率为46.9%。术后躯干偏移较术前均有明显改善，末次随访冠状面及矢状面的矫正率分别为53.1%和56.3%，且随访过程中躯干趋于平衡和稳定。所有病例术前、术后脊柱-骨盆序列均保持平衡，术后无脊髓神经功能损伤、感染等并发症。结论 儿童腰骶部半椎体畸形一期后路半椎体切除、短节段固定可获得较好的侧凸矫正并改善躯干偏移，同时可保留一定的活动节段，有效控制畸形的加重和近端代偿弯的进展，避免腰椎长节段的固定融合。
- Abstract:
- Objective To evaluate the surgical outcomes of one-stage posterior-only lumbosacral hemivertebra resection with short-segment internal fixation and fusion in children.Methods This retrospective reviews were conducted for the clinical data of 21 congenital scoliosis children with lumbosacral hemivertebra undergoing one-stage posterior-only hemivertebra resection with short-segment internal fixation and fusion,with at least a 24-month follow-up,from Jun 2014 to Dec 2017.Standing anteroposterior and lateral radiographs of full spine were acquired and compared pre-operatively,post-operatively and at the last follow-up.Radiographic evaluation included measured changes in segmental scoliosis and lordosis,compensatory scoliosis,thoracic kyphosis,lumbar lordosis,trunk shift,sagittal vertical axis,pelvic incidence,pelvic tilt and sacral slope.Results There are 12 boys and 9 girls with an average age of 6.50±3.22(2.17~13.00)years.The mean follow-up period was 48.10±17.72(24~84) months.The mean fusion level was 2.67±0.91(2~4) segments.Mean operation time was 168.57±46.18(120~300)min with the average blood loss of 368.04±234.58(100~1 000)mL.The mean segmental scoliosis was 28.9±6.3°preoperatively,8.5±3.0° (correction rate of 70.6%) postoperatively,and 7.0±3.4°(correction rate of 75.8%) at the latest follow-up.The compensatory coronal curve of 25.8±11.7° was spontaneously corrected to 13.7±8.3°(correction rate of 46.9%) at most recent follow-up.Trunk shift was significantly improved on both coronal (53.1%) and sagittal (56.3%) plane after surgery,and kept stable during the follow-up.The sagittal pelvic was balanced in all cases.There were no neurologic and infectious complications.Conclusion One-stage posterior-only lumbosacral hemivertebra resection with short-segment internal fixation and fusion in children can offer excellent scoliosis correction and trunk shift improvement,while saving motion segments as much as possible.This strategy is not only corrective of the deformity but also preventive of compensatory curve progression,thus avoiding long lumbar fusion.
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备注/Memo
收稿日期:2019-05-26。
基金项目:国家重点研发计划（编号：2016YFC1000806）
通讯作者:张学军,Email:zhang-x-j04@163.com