【作者】 许伟华； 杨述华； 杜靖远； CARSTENS Claus；

【Author】 XU Wei-hua,YANG Shu-hua,DU Jing-yuan,CARSTENS Claus Orthopaedic Department,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology.Wuhan 430022 China

【机构】 华中科技大学同济医学院协和医院骨科；

【摘要】 目的:评估半椎体切除和短节段椎弓根钉系统固定融合治疗先天性脊柱侧弯的疗效。方法:34例经前后路联合半椎体切除并同时行后路短节段椎弓根螺钉矫形内固定脊柱融合术的先天性脊柱侧弯的患者,随访术前、术后和最后一次脊柱全长正侧位X光片,测量并记录脊柱侧弯及后凸的Cobb角。结果:除一例因(T11-12)半椎体畸形术后因术后5月椎弓根钉脱出、假关节形成、侧弯加重外,其余病例冠状面半椎体节段侧弯术前平均45.3°,术后14.9°,矫正67.1%;最后一次随访时平均13.5°,矫正70.2%;冠状面主侧弯术前平均47.6°,术后18.2°,矫正61.8%;最后一次随访时平均16.0°,矫正66.4%;矢状面半椎体节段术前有10.1°后凸畸形,术后恢复至正常生理曲度范围。手术后头侧和尾侧代偿弯也得到明显改善。结论:前后入路联合切除半椎体后,使用短节段的椎弓根螺钉系统可满意地矫正先天性脊柱侧弯,在骨骼成熟之前进行治疗可有效地预防脊柱的继发性改变。更多还原

【Abstract】 Objectives To evaluate surgical outcomes of hemivertebra resection through combined anterior and posterior approach and short-segment fusion with transpedicular instrumentation.Methods A group of patients with a single hemivertebra between the ages 5-16 years who underwent operative treatment were evaluated.After hemivertebra resection combined anterior and posterior approach,short-segment transpedicular instrumentation was used for correction of the scoliosis and kyphosis deformities.Radiographic evaluation were conducted on the preoperative,postoperative and follow-up posteroanterior and lateral radiographs.Cobb angles of the segmental curve,total main curve,cranial and caudal compensatory curves posteroanteriorly and kyphosis laterally were measured.Results Except one patient with Tll-12 hemivertebra exhibited transpedicular srews pulled out,pseudoarthrosis formation and scoliosis deterioration.All the remaining cases showed satisfied results, the mean Cobb angle of segment curve was 45.3°before surgery and 14.9°after surgery with a 67.1% correction,and 13.5°at the Lastest follow-up assessment with a 70.2%correction;total main curves improved from 47.6°to 18.2°,for a 61.8%correction;16.0°at latest follow-up,for a 66.4% correction;the correction ratio for kyphosis was-161.3%,from 10.1°kyphosis to normal physical profile;cranial and caudal compensartory curves were improved obviously,too.Conclusions Hemivertebra resection through combined anterior and posterior approach and short-segment transpedicular instrumentation could exert satisfied correction on congenital scoliosis.If the operation performed before the maturity of the bone,it would effectively prevent the formation of secondly spinal deformities.更多还原