10岁以下儿童先天性脊柱侧弯的后路半椎体切除及短节段椎弓根螺钉固定融合术：超过7年的随访
Posterior hemivertebra resection and short segment fusion with pedicle screw fixation for congenital scoliosis in children younger than 10 years: greater than 7-year follow-up.
作者信息
Chang Dong-Gune, Kim Jin-Hyok, Ha Kee-Yong, Lee Jung-Sub, Jang Ji-Seok, Suk Se-Il
机构信息
*Seoul Spine Institute, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul, Korea †Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea; and ‡Department of Orthopaedic Surgery, Pusan National University School of Medicine, Busan, Korea.
出版信息
Spine (Phila Pa 1976). 2015 Apr 15;40(8):E484-91. doi: 10.1097/BRS.0000000000000809.
STUDY DESIGN
A retrospective study.
OBJECTIVE
To evaluate the surgical outcomes of posterior hemivertebra resection and short segment fusion with segmental pedicle screw fixation in congenital scoliosis in children younger than 10 years.
SUMMARY OF BACKGROUND DATA
This is the first long-term follow-up on surgical outcomes of posterior hemivertebra resection and short segment fusion using segmental pedicle screw fixation in children younger than 10 years with congenital scoliosis.
METHODS
Patients with congenital scoliosis (n = 18) younger than 10 years at the time of the surgery were treated by posterior hemivertebra resection and bilateral pedicle screw fixation. The mean age at the time of surgery was 6.6 years (range, 2.6-9.8 yr). They were retrospectively studied with a mean follow-up of 11.4 years (range, 7.1-17.3 yr).
RESULTS
The mean Cobb angle of the main curve was 34.4° before surgery, 8.6° after surgery, and 12.9° at last follow-up. In the compensatory cranial curve, the preoperative Cobb angle of 14.5° was corrected to 5.9° postoperatively and was 8.4° at last follow-up. In the compensatory caudal curve, the preoperative Cobb angle of 17.4° improved to 4° postoperatively and 6.6° at last follow-up. There were no crankshaft phenomena and no clinical and radiographical features suggestive of spinal stenosis during follow-up. There were no major vascular or neurological complications related to the pedicle screws.
CONCLUSION
Posterior hemivertebra resection after pedicle screw fixation in congenital scoliosis is a safe and effective procedure that can achieve rigid fixation and deformity correction and restore spinal balance. This study showed that early posterior hemivertebra resection of congenital scoliosis before structural changes occur above or below can reduce fusion length, prevent curve progression, and effectively achieve a more satisfactory correction without hazardous iatrogenic spinal stenosis, crankshaft phenomena, or neurological complications.
LEVEL OF EVIDENCE
研究设计
一项回顾性研究。
目的
评估后路半椎体切除术及短节段融合并节段性椎弓根螺钉固定治疗10岁以下儿童先天性脊柱侧凸的手术效果。
背景资料总结
这是首例对10岁以下先天性脊柱侧凸儿童采用后路半椎体切除术及短节段融合并节段性椎弓根螺钉固定的手术效果进行的长期随访研究。
方法
对18例手术时年龄小于10岁的先天性脊柱侧凸患者行后路半椎体切除术及双侧椎弓根螺钉固定。手术时的平均年龄为6.6岁（范围2.6 - 9.8岁）。对他们进行回顾性研究，平均随访11.4年（范围7.1 - 17.3年）。
结果
主弯术前平均Cobb角为34.4°，术后为8.6°，末次随访时为12.9°。在代偿性的上位曲线中，术前Cobb角14.5°术后矫正至5.9°，末次随访时为8.4°。在代偿性的下位曲线中，术前Cobb角17.4°术后改善至4°，末次随访时为6.6°。随访期间无曲轴现象，也无提示椎管狭窄的临床及影像学特征。未出现与椎弓根螺钉相关的严重血管或神经并发症。
结论
先天性脊柱侧凸行椎弓根螺钉固定后后路半椎体切除术是一种安全有效的手术方法，可实现坚强固定、矫正畸形并恢复脊柱平衡。本研究表明，在先天性脊柱侧凸上下方结构改变之前早期行后路半椎体切除术可缩短融合长度、防止侧弯进展，并有效实现更满意的矫正，且无医源性椎管狭窄、曲轴现象或神经并发症等风险。
证据等级
3级。
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