Feng Fan, Shen Jianxiong, Zhang Jianguo, Zhao Hong, Zhao Yu, Li Zheng, Xue Xuhong, Lin Youxi, Qiu Guixing
From the Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China.
Spine (Phila Pa 1976). 2016 Aug 15;41(16):1310-1316. doi: 10.1097/BRS.0000000000001530.
A retrospective study.
To compare the clinical outcomes of different surgical strategy for patients with congenital scoliosis (CS) and type I split cord malformation (SCM).
CS associated with type I SCM is a challenge for spine surgeon because of the high potential rate of neurological compromise. Traditionally, bony spur resection (BR) has been indicated before any procedure for scoliosis correction.
From May 2002 to February 2013, 82 CS patients with type I SCM who underwent corrective surgery at our center were retrospectively reviewed. There were 20 male and 62 female patients with an average age of 13.8 years (4-39 yrs) at surgery. They were divided into two groups according to different surgical strategy. The patients in the BR group underwent staged prophylactic neurosurgery or one-stage BR before corrective surgery, whereas patients in the nonresection (NR) group underwent one-stage corrective surgery without addressing bony spur.
There were 15 patients in the BR group and 67 patients in the NR group. No significant differences were detected in preoperative characteristics between two groups. The average follow up was 37 months (24-105 months). In the BR group, the correction rate was 53.0% and 45.9% at the final follow up. Whereas, in the NR group, the correction rate was 48.5% and 42.1% at the final follow up. Compared with the NR group, the operation time and blood loss were statistically higher in the BR group. Five patients experienced transient neurological complications and one patient in the BR group suffered permanent neurological damage of incomplete loss bladder control.
One-stage corrective surgery could be safe and effective for patients with CS and SCM. For patients with intact or stable neurological status, prophylactic neurosurgical intervention to remove bony spur before curve correction may not be necessary.
一项回顾性研究。
比较先天性脊柱侧凸（CS）合并Ⅰ型脊髓纵裂畸形（SCM）患者不同手术策略的临床疗效。
CS合并Ⅰ型SCM因神经功能损害的潜在发生率高，对脊柱外科医生而言是一项挑战。传统上，在进行任何脊柱侧凸矫正手术之前，均需先行骨赘切除术（BR）。
回顾性分析2002年5月至2013年2月在本中心接受矫正手术的82例CS合并Ⅰ型SCM患者。其中男性20例，女性62例，手术时平均年龄13.8岁（4 - 39岁）。根据不同手术策略将患者分为两组。BR组患者在矫正手术前行分期预防性神经外科手术或一期BR，而未切除（NR）组患者行一期矫正手术，未处理骨赘。
BR组15例患者，NR组67例患者。两组术前特征无显著差异。平均随访37个月（24 - 105个月）。BR组末次随访时的矫正率分别为53.0%和45.9%。而NR组末次随访时的矫正率分别为48.5%和42.1%。与NR组相比，BR组手术时间和失血量在统计学上更高。5例患者出现短暂性神经并发症，BR组1例患者发生永久性神经损伤，膀胱控制不完全丧失。
一期矫正手术对CS合并SCM患者可能是安全有效的。对于神经功能状态完整或稳定的患者，在矫正侧弯前进行预防性神经外科干预以切除骨赘可能没有必要。
4级。
