【作者】 郑燕平； 刘新宇； 贾龙； 王延国； 黎君彦； 田亚丽；

【Author】 Zheng Yanping,Liu Xinyu,Jia Long, Li Junyan.Department of Orthopedics,Qilu Hospital,Shandong University,Jinan 250012,China

【机构】 山东大学齐鲁医院骨科脊柱组；

【摘要】 目的总结单一后路半脊椎切除治疗青少年先天性脊柱侧后凸畸形的2年以上随访结果。方法本组41例,男1 7例,女24例;平均16.4岁（11-18）。其中完全分节侧方半脊椎畸形33例,完全分节后方半脊椎畸形8例。37例切除单个半脊椎,4例切除2个半脊椎。病变部位:T₄ 3例,T₆ 4例,T₇ 5例,T₉ 3例,T₁₀ 4例,T₁₁ 5例,T₁₂ 6例,L₂ 3例,L₃ 3例,L₄ 4例,L₅ 3例,S₁ 2例。合并椎管内骨性间隔脊髓纵裂2例,脊髓栓系1例,胸段脊髓空洞症1例,Chiari畸形1例。平均冠状面Cobb角74.0±15.2°,平均矢状面Cobb角31.3±11.1°结果手术时间250±60min,术中失血为900±114ml。单纯半脊椎切除、短节段固定8例;半脊椎切除并侧后凸矫形33例。融合节段平均3.9个,3例患者术中胸膜破裂、1例术后双下肢瘫痪,经积极治疗3个月恢复正常。术后冠状面平均21±6.9°,平均矫正率为74.6%;矢状面Cobb角平均20.2±4.2°,平均矫正率35.6%,术后平均身高增长2.5±1.1cm。所有患者术后均获得2年以上随访,随访时间24～36个月,平均29.6个月。随访时冠状面平均25.0±7.1°,矫正平均丢失3.1±0.3°;矢状面Cobb角平均21.3±3.3°,矫正平均丢失1.1±0.2°。结论单一后路半脊椎切除并侧后凸矫形术畸形矫正率高、2年以上随访时矫正角度丢失少,疗效可靠。更多还原

【Abstract】 Objective:To analysis the two years follow-up results of hemivertebra resection with transpedicular instrumentation by a posterior approach.Methods: Forty-eight cases of congenital deformity underwent hemivertebra resection with transpedicular instrumentation by a posterior approach,including 17 males and 24 females.The mean age of the patients was 16.4±3.1years（11-18 years）.Thirty-seven cases had one while the other 4 cases had two hemivertebra.The hemivertebra located at T4 in 3 cases,T₆ in 4 cases,T₇ in 5 cases,T₉ in 3 cases,L₂ in 3 cases,T₁₀ in 4 cases,4,T₁₁ in 5 cases,T₁₂ in 6 cases,L₃ in 3 cases,L₄ in 4 cases,L₅ in 3 case and S₁ in 2 cases.Two cases were associated with bony diastematomyelia,one case with tethered cord and 1 cases with syrinogmyelia.The average coronal Cobb’ s angle was 74.0±15.2°,while the sagittal Cobb’ s angle was 31.3±11.1°.Result:The operation time was 250±60mins.The blood loss was 900±114ml.The average fusion levels were 3.9±1.1.The postoperative coronal and sagittal Cobb’ s angle was 21±6.9°and 20.2±4.2°,respectively.The patients were 2.5±1.1cm taller on average after operation.The coronal corrective rate was 74.6%while sagittal corrective rate was 35.6%.Three cases occurred the CSF leakage,1 case had serious neurologic complication but recovered 3 months later.The mean follow-up was 29.6±5.6 months.According to the latest results,the coronal and sagittal Cobb’ s angle was 25.0±7.1°and 21.3±3.3°,respectively.Conclusion:Surgical excision of the hemivertebra in congenital scoliosis through single posterior approach is an safe and effective procedure for the hemivertebrae deformity with less complications and better clinical results according to the two years follow-up.更多还原