Department of Orthopaedic Surgery, Osaka City General Hospital.
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
J Pediatr Orthop B. 2020 Nov;29(6):572-579. doi: 10.1097/BPB.0000000000000729.
The purpose of this study was to assess the surgical outcomes of posterior vertebral column resection (PVCR) with short-segment fusion for pediatric patients with congenital kyphoscoliosis (CKS). The medical records of 12 consecutive pediatric patients with CKS due to hemivertebrae located in thoracolumbar and lumbar area that had undergone PVCR and presented for follow-up at a minimum of 2 years were retrospectively reviewed. The mean follow-up period was 56.2 months, and the mean age at the surgery was 9.2 years. We evaluated radiographic parameters using plain radiographs, and evaluated segmental correction using computed tomography imaging. The mean values of the preoperative Cobb angle (cranial curve, main curve, and caudal curve) were 16.0°, 41.3°, and 25.0°, respectively. The main curve was reduced 5.4° after surgery and was maintained at 6.3° at the time of the most recent follow-up. The overall correction rate of main curve was 86.6%. Spontaneous correction rate in the cranial curve and caudal curve were calculated as 55.9 and 80.8%, respectively. The mean segmental scoliosis in the osteotomized segments and fused segments at preoperative/postoperative/final follow-up (FFU) were 40.8°/7.8°/9.2° and 34.3°/3.9°/5.1°, respectively. The mean segmental kyphosis in the osteotomized segments and fused segments at the preoperative/postoperative/FFU were 36.0°/3.8°/4.0° and 27.5°/-1.3°/0.7°, respectively. Our data indicate that PVCR with short-segment fusion for CKS can provide good correction in the main curve and spontaneous correction in the compensatory curves after a minimum 2-year follow-up. Further investigation over the long term is mandatory for pediatric patients.
本研究旨在评估后路全脊椎切除短节段融合术（PVCR）治疗儿童先天性脊柱侧后凸（CKS）的手术效果。回顾性分析 12 例因半椎体位于胸腰段和腰段而导致 CKS 的儿童患者的临床资料，所有患者均接受了 PVCR 治疗，并在至少 2 年时进行了随访。平均随访时间为 56.2 个月，手术时的平均年龄为 9.2 岁。我们使用 X 线平片评估影像学参数，并使用 CT 成像评估节段矫正情况。术前 Cobb 角（颅侧曲线、主曲线和尾侧曲线）的平均测量值分别为 16.0°、41.3°和 25.0°。术后主曲线减少 5.4°，末次随访时维持在 6.3°。主曲线的总体矫正率为 86.6%。颅侧曲线和尾侧曲线的自发性矫正率分别为 55.9%和 80.8%。术前/术后/末次随访（FFU）时，截骨段和融合段的平均节段性脊柱侧凸分别为 40.8°/7.8°/9.2°和 34.3°/3.9°/5.1°；术前/术后/FFU 时，截骨段和融合段的平均节段性后凸分别为 36.0°/3.8°/4.0°和 27.5°/-1.3°/0.7°。我们的数据表明，后路全脊椎切除短节段融合术治疗儿童先天性脊柱侧凸，在至少 2 年的随访中，主曲线可获得良好的矫正，代偿性曲线可自发矫正。对于儿童患者，需要进行长期的进一步研究。
