Guo Dong, Yao Ziming, Qi Xinyu, Li Chengxin, Zhang Xuejun
Department of Orthopaedics Beijing Children's Hospital Capital Medical University, National Center for Children's Health China.
Pediatr Investig. 2020 Jun 24;4(2):104-108. doi: 10.1002/ped4.12206. eCollection 2020 Jun.
Congenital hemivertebra is commonly treated with posterior hemivertebra resection with bilateral transpedicular fixation. However, implant-related complications are common in children younger than 5 years old who undergo this surgical procedure.
To present the preliminary clinical and radiological outcomes of children younger than 5 years old treated by posterior hemivertebra resection and 3-rod fixation technique.
From January 2016 to December 2017, 14 consecutive patients of congenital scoliosis with 16 hemivertebrae were retrospectively reviewed, including 5 girls and 9 boys, aged between 25 and 55 months old (average, 37.6 months). All patients underwent posterior hemivertebra resection with short fixation with bilateral pedicle screws and a convex lamina hook. Surgical complications and corrective outcomes were assessed based on the clinical charts and spinal radiographs with a minimum 24-month follow-up.
The mean Cobb angle of the main curve was 38.4° before surgery, 8.5° after surgery, and 8.7° at final follow-up. In the compensatory cranial curve, the preoperative Cobb angle of 16.8° was corrected to 8.1° postoperatively and was 10.3° at final follow-up. In the compensatory caudal curve, the preoperative Cobb angle of 15.9° improved to 5.3° postoperatively and was 7.8° at final follow-up. The segmental kyphosis was corrected from 13.5° to 0.5° and was 1.1° at final follow-up. There were no crankshaft phenomena, no proximal kyphosis, and no complications related to the instrumentation.
Posterior hemivertebra resection with instrumentation with bilateral pedicle screws and a convex lamina hook can achieve rigid fixation and deformity correction.
先天性半椎体通常采用后路半椎体切除并双侧椎弓根固定进行治疗。然而，在接受该手术的5岁以下儿童中，植入物相关并发症很常见。
介绍采用后路半椎体切除及三棒固定技术治疗5岁以下儿童的初步临床和影像学结果。
回顾性分析2016年1月至2017年12月连续收治的14例先天性脊柱侧弯合并16个半椎体的患者，其中女孩5例，男孩9例，年龄在25至55个月之间（平均37.6个月）。所有患者均接受后路半椎体切除，采用双侧椎弓根螺钉和凸侧椎板钩进行短节段固定。根据临床病历和脊柱X线片评估手术并发症和矫正效果，随访至少24个月。
主弯术前平均Cobb角为38.4°，术后为8.5°，末次随访时为8.7°。在代偿性头侧弯曲中，术前Cobb角16.8°术后矫正至8.1°，末次随访时为10.3°。在代偿性尾侧弯曲中，术前Cobb角15.9°术后改善至5.3°，末次随访时为7.8°。节段性后凸从13.5°矫正至0.5°，末次随访时为1.1°。未出现曲轴现象、近端后凸，也未出现与内固定相关的并发症。
采用双侧椎弓根螺钉和凸侧椎板钩进行后路半椎体切除及内固定可实现坚强固定和畸形矫正。
