Department of Orthopaedic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Spine J. 2011 Feb;11(2):111-8. doi: 10.1016/j.spinee.2010.08.028. Epub 2010 Oct 15.
The treatment of adolescent congenital deformity (late-diagnosed congenital deformity) is still unknown. The best candidates for hemivertebra excision are young patients, typically between 4 and 6 years of age. Partial excision may be feasible for older children.
The purpose of this study was to assess the effect of unilateral pedicle subtraction osteotomy of hemivertebra for correction of the adolescent congenital spinal deformity.
Retrospective analysis.
Twelve patients with adolescent congenital deformity who underwent posterior unilateral pedicle subtraction osteotomy and correction were evaluated. Mean age at the time of surgery was 17 years.
The charts, standing full-length posteroanterior and lateral view radiographs, and functional measures were reviewed.
For evaluation of surgical effectiveness, comparative analysis of the parameters of the total main curve, the segmental curve, the compensatory cranial and caudal curves, the segmental kyphosis, and the trunk shift before and after operation and at the most recent follow-up was done.
The mean follow-up period was 40.5 months. Mean Cobb angles of the total main curve and the segmental curve were, respectively, 47.5° and 43.8° before surgery, 23.7° and 16.5° after surgery, and 22.6° and 17° at the last follow-up. The angle of segmental kyphosis was 11.8° before surgery, 6.2° after surgery, and 7.8° (range, -30° to 26°) at the final follow-up. The mean final global lordosis was within the normal range. No neurologic deficit occurred. Solid fusion was achieved for all cases.
Unilateral pedicle subtraction osteotomy with instrumentation from a posterior-only approach is indicated in older teenagers for an adolescent congenital spinal deformity. Compared with hemivertebra excision, corrective surgery with hemivertebra osteotomy has a lower intraoperative blood loss and shorter operation time.
青少年先天性畸形（迟发性先天性畸形）的治疗仍不明确。接受半椎体切除术的最佳候选人群为 4 至 6 岁的年轻患者。对于年龄较大的儿童，部分切除可能是可行的。
本研究旨在评估后路单侧半椎体切除截骨术矫正青少年先天性脊柱畸形的效果。
回顾性分析。
12 例接受后路单侧半椎体切除截骨和矫正的青少年先天性脊柱畸形患者。手术时的平均年龄为 17 岁。
回顾病历资料、站立全长正侧位片和功能测量。
为评估手术效果，对手术前后及末次随访时的总主弯、节段性弯、代偿性颅侧和尾侧弯、节段性后凸和躯干偏移等参数进行了比较分析。
平均随访时间为 40.5 个月。术前总主弯和节段性弯 Cobb 角分别为 47.5°和 43.8°，术后为 23.7°和 16.5°，末次随访时为 22.6°和 17°。节段性后凸角术前为 11.8°，术后为 6.2°，末次随访时为 7.8°（范围-30°至 26°）。最终全局后凸平均在正常范围内。无神经功能缺损发生。所有病例均获得了牢固的融合。
后路单侧半椎体切除截骨并结合器械固定是大龄青少年先天性脊柱畸形的一种治疗方法。与半椎体切除相比，半椎体截骨矫形术具有术中出血量少、手术时间短的优点。
