Department of Spine Surgery and Orthopaedics, Xiangya Hospital of Central-South University, Changsha, China.
Orthop Surg. 2022 Sep;14(9):2050-2058. doi: 10.1111/os.13480. Epub 2022 Aug 30.
Cervicothoracic scoliosis will cause severe deformities in the early stage, and its structure is complex and the surgical methods are varied. The purpose of this research is to explore the indication and analyze the corrective effect of the two different posterior approach surgical strategies, including correction with fusion and hemivertebra osteotomy, for congenital cervicothoracic scoliosis deformities in children and adolescents.
This was a retrospective study of 21 patients with cervicothoracic scoliosis who received surgical treatment from January 2010 to June 2020, including nine cases of posterior hemivertebra osteotomy and fusion surgery and 12 cases of posterior correction and fusion alone. The Cobb angle, T1 tilt angle, clavicular angle, neck tilt angle, radiographic shoulder height, sagittal vertical axis, coronal balance distance, and local kyphosis angle were measured preoperatively, postoperatively, and at the last follow-up. Posterior approach hemivertebra resection or correction with fusion surgery was adopted based on the different individual characteristics of deformity such as main curve Cobb angle, growth potential, and flexibility. Patients were divided into two groups (osteotomy group and nonosteotomy group) according to whether a hemivertebra osteotomy was performed, and the corrective results in the two groups were compared. Paired-sample t tests or independent-sample t tests were used.
The median follow-up after surgery of the 21 patients was 36 months (range, 18-72 months). The Cobb angle was corrected from 45.81° ± 14.23° preoperatively to 10.48° ± 5.56° postoperatively (correction rate, 77.78% ± 8.93%). The T1 tilt angle decreased from 15.26° ± 7.08° preoperatively to 3.33° ± 2.14° postoperatively (correction rate,73.42% ± 21.86%). The radiographic shoulder height was corrected from 1.13 ± 0.74 cm preoperatively to 0.52 ± 0.42 cm postoperatively (correction rate, 39.51% ± 35.65%). The clavicular angle improved from 2.52° ± 1.55° preoperatively to 1.16° ± 0.96° postoperatively (correction rate, 47.18% ± 35.84%). No significant differences were found at the last follow-up (p > 0.05). The Cobb angle of the main curve, T1 tilt angle, clavicular angle, cervical tilt angle, and shoulder height difference were similar in the two groups (p > 0.05).
Posterior approach hemivertebra resection or correction with fusion surgery can be used in the treatment of congenital cervicothoracic scoliosis with satisfactory results, and the surgeon can make an individualized surgical plan according to individual characteristics of deformity.
先天性颈胸段脊柱侧凸早期即出现严重畸形，其结构复杂，手术方式多样。本研究旨在探讨两种不同后路手术策略（融合矫正和半椎体切除）治疗儿童青少年先天性颈胸段脊柱侧凸畸形的适应证，并分析其矫正效果。
回顾性分析 2010 年 1 月至 2020 年 6 月接受手术治疗的 21 例先天性颈胸段脊柱侧凸患者的临床资料，其中后路半椎体切除融合术 9 例，后路单纯矫正融合术 12 例。测量术前、术后和末次随访时的 Cobb 角、T1 倾斜角、锁骨角、颈倾角、影像学肩高、矢状垂直轴、冠状平衡距离和局部后凸角。根据主弯 Cobb 角、生长潜能和柔韧性等畸形的个体特征，采用后路半椎体切除或单纯矫正融合术。根据是否行半椎体切除术将患者分为两组（切除组和非切除组），比较两组的矫正效果。采用配对样本 t 检验或独立样本 t 检验。
21 例患者术后中位随访时间为 36 个月（18～72 个月）。Cobb 角由术前的 45.81°±14.23°矫正至术后的 10.48°±5.56°（矫正率 77.78%±8.93%）。T1 倾斜角由术前的 15.26°±7.08°矫正至术后的 3.33°±2.14°（矫正率 73.42%±21.86%）。影像学肩高由术前的 1.13±0.74 cm 矫正至术后的 0.52±0.42 cm（矫正率 39.51%±35.65%）。锁骨角由术前的 2.52°±1.55°矫正至术后的 1.16°±0.96°（矫正率 47.18%±35.84%）。末次随访时差异均无统计学意义（P>0.05）。两组患者主弯 Cobb 角、T1 倾斜角、锁骨角、颈倾角和肩高差值比较差异均无统计学意义（P>0.05）。
后路半椎体切除或单纯矫正融合术可用于治疗先天性颈胸段脊柱侧凸，效果满意，术者可根据畸形的个体特征制定个体化的手术方案。
