Department of Orthopaedics, Children's Hospital of Hebei Province, Shijiazhuang, China.
Orthop Surg. 2021 Feb;13(1):98-108. doi: 10.1111/os.12838. Epub 2020 Nov 30.
To compare the surgical effect of children with symmetrical screw fixation and asymmetric screw fixation during posterior hemivertebra excision and short-segment pedicle screw fixation for the treatment of congenital scoliosis (CS).
A total of 30 children with CS who underwent posterior hemivertebra excision and short-segment bilateral pedicle screw fixation in our hospital from 2012 to 2018 were retrospectively included and were divided into two groups: symmetric fixation group (n = 18) and asymmetric fixation group (n = 12). The total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, coronal balance, and apical vertebra translation were measured in the coronal plane. The segmental kyphosis, thoracic kyphosis, lumbar lordosis, and sagittal balance were measured in the sagittal plane.
Of the 30 children, 28 hemivertebrae were resected. Twenty-two children had one hemivertebra, three had two hemivertebrae, and five were rib deformities. The average operation time was 268 min (180-420 min). The average blood loss was 291 mL (150-550 mL). The average follow-up was 21.1 months (12-47 months). For symmetric fixation group and there were significant differences among postoperative and follow-up parameters including the total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, apical vertebra translation and segmental kyphosis compared with those of preoperative parameters (P < 0.05). The postoperative coronal balance was significantly lower than preoperative coronal balance (P < 0.05). The follow-up thoracic kyphosis was significantly higher than preoperative and postoperative thoracic kyphosis (P < 0.05). For asymmetric fixation group, the postoperative and follow-up parameters including the total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, apical vertebra translation, and segmental kyphosis had statistical differences compared with those of preoperative parameters (P < 0.05). The postoperative sagittal balance was significantly higher than preoperative postoperative (P < 0.05). There were no significant differences in the postoperative and follow-up correction rate and correction loss between the two groups (P > 0.05). There were three complications in 30 children in our study, including two cases who had poor wound healing, and the wound healed smoothly after half a month of sterile dressing change. Postoperative curve progression occurred in one case after T and L hemivertebra resection and thoracic hemivertebra resection was planned again.
For pedicles which were difficult for screw fixation, adjacent segments can be chosen for screw fixation and it is safe and effective for vertebral pedicles ≤3 without internal fixation.
比较儿童在后路半椎体切除和短节段双侧椎弓根螺钉固定治疗先天性脊柱侧凸（CS）中采用对称螺钉固定和非对称螺钉固定的手术效果。
回顾性分析 2012 年至 2018 年我院收治的 30 例后路半椎体切除和短节段双侧椎弓根螺钉固定治疗 CS 患儿的临床资料，根据螺钉固定方式的不同分为对称固定组（n=18）和非对称固定组（n=12）。测量冠状面的总主曲线、节段主曲线、颅侧代偿曲线、尾侧代偿曲线、冠状面平衡和顶椎位移。测量矢状面的节段后凸、胸椎后凸、腰椎前凸和矢状面平衡。
30 例患儿共切除 28 个半椎体，其中单半椎体 22 例，双半椎体 3 例，肋骨畸形 5 例。平均手术时间为 268 min（180420 min），平均出血量为 291 mL（150550 mL），平均随访时间为 21.1 个月（12~47 个月）。对称固定组术后及随访的总主曲线、节段主曲线、颅侧代偿曲线、尾侧代偿曲线、顶椎位移和节段后凸与术前比较差异均有统计学意义（P<0.05）。术后冠状面平衡明显低于术前（P<0.05）。随访时胸椎后凸明显高于术前和术后（P<0.05）。非对称固定组术后及随访的总主曲线、节段主曲线、颅侧代偿曲线、尾侧代偿曲线、顶椎位移和节段后凸与术前比较差异均有统计学意义（P<0.05）。术后矢状面平衡明显高于术前和术后（P<0.05）。两组术后及随访的矫正率和矫正丢失差异均无统计学意义（P>0.05）。本研究 30 例患儿共发生 3 例并发症，其中 2 例切口愈合不良，经半个月无菌换药后切口愈合顺利；1 例 T、L 半椎体切除术后出现脊柱侧凸进展，再次行胸椎半椎体切除。
对于椎弓根螺钉固定困难的节段，可以选择相邻节段进行螺钉固定，对于椎弓根≤3 节段的患者，不内固定也是安全有效的。
