Department of Orthopaedic Surgery, Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh, Scotland, UK EH9 1LF.
J Bone Joint Surg Am. 2013 Jun 5;95(11):972-9. doi: 10.2106/JBJS.L.01096.
Congenital scoliosis due to a unilateral failure of vertebral segmentation usually has a poor prognosis. However, not all curves progress to the same degree or develop the same spinal deformity.
The medical records and spine radiographs of 171 patients with a scoliosis due to unilateral unsegmented bar were reviewed retrospectively. The mean patient age at diagnosis was 9.3 years. Thirty-six patients had immediate surgery, 103 immature patients were followed untreated or before surgery for a mean duration of 3.6 years, twenty-eight patients were seen untreated at skeletal maturity, and four patients had no follow-up.
The unsegmented bar occurred at all levels; the mean extent was three vertebrae (range, two to eight vertebrae). Before the age of ten years, patients had a mean rate of scoliosis progression without treatment for all regions of the spine of 2° to 3° per year. By the age of ten years, seventy-three patients who had been seen untreated or prior to treatment had a mean scoliosis of 50° (range, 18° to 100°). After the age of ten years, these patients had an increase in the mean rate of scoliosis progression, but this rate varied per year depending on the affected region of the spine: 7° for the thoracolumbar curve, 5° for the midthoracic curve, and 4° for the upper thoracic curve. Spine surgery was performed on seventy-four patients who had a mean age of 12.2 years and a mean scoliosis of 78° for thoracolumbar curves, 66° for midthoracic curves, and 54° for upper thoracic curves. Of the patients with midthoracic congenital scoliosis, 24% developed a lower structural compensatory curve, which became larger and more deforming than the congenital curve, 22% had congenital rib fusions, and 16% had occult intraspinal anomalies.
Prognosis depends on growth imbalance at the site of the unsegmented bar as well as the location and extent of the bar, age at diagnosis, and spinal growth remaining.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
由于单侧椎体分节不全导致的先天性脊柱侧凸通常预后较差。然而，并非所有的曲线都会以相同的程度进展或发展出相同的脊柱畸形。
回顾性分析了 171 例单侧未分节椎板所致脊柱侧凸患者的病历和脊柱 X 线片。患者诊断时的平均年龄为 9.3 岁。36 例患者立即行手术治疗，103 例未成熟患者未治疗或在手术前平均随访 3.6 年，28 例患者在骨骼成熟时未治疗，4 例患者无随访。
未分节椎板发生于所有节段；平均范围为 3 个椎体（2 至 8 个椎体）。在 10 岁之前，未经治疗或治疗前的患者脊柱各部位的脊柱侧凸进展率平均为每年 2°至 3°。10 岁时，73 例未经治疗或治疗前的患者脊柱侧凸平均为 50°（18°至 100°）。10 岁以后，这些患者的脊柱侧凸进展率增加，但每年的增长率因受累脊柱区域而异：胸腰椎曲线为 7°，中胸段曲线为 5°，上胸段曲线为 4°。74 例平均年龄为 12.2 岁的患者接受了脊柱手术，胸腰椎曲线的平均脊柱侧凸为 78°，中胸段曲线为 66°，上胸段曲线为 54°。中胸段先天性脊柱侧凸患者中，24%出现下结构性代偿性曲线，该曲线比先天性曲线更大、更畸形，22%存在先天性肋骨融合，16%存在隐性椎管内异常。
预后取决于未分节椎板处的生长失衡、椎板的位置和范围、诊断时的年龄以及脊柱的生长潜力。
预后 II 级。有关证据水平的完整描述，请参见作者须知。
