儿童一期单纯后路腰骶半椎体切除术联合短节段融合术的中长期手术疗效
Medium-term and Long-term Follow-up Surgical Outcomes of the 1-stage Posterior-only Lumbosacral Hemivertebra Resection With Short-segment Fusion in Children.
作者信息
Gao Rongxuan, Zhang Xuejun, Guo Dong, Cao Jun, Yao Ziming, Bai Yunsong, Sun Baosheng
机构信息
Department of Orthopaedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, PR China.
出版信息
J Pediatr Orthop. 2023 Feb 1;43(2):e120-e126. doi: 10.1097/BPO.0000000000002263. Epub 2022 Sep 6.
BACKGROUND
The objective of this study was to evaluate the medium-term and long-term surgical outcomes of the 1-stage posterior-only lumbosacral hemivertebra resection with short-segment fusion in children.
METHODS
This retrospective chart review included 21 children with congenital scoliosis due to lumbosacral hemivertebra who received 1-stage posterior-only hemivertebra resection with short-segment fusion from 2012 to 2016 with at least 5 years of follow-up. Standing anteroposterior and lateral radiographs of the spine were compared preoperatively, postoperatively, and at last follow-up. Radiographic evaluation included measured changes in segmental scoliosis and lordosis, compensatory scoliosis, thoracic kyphosis, lumbar lordosis, trunk shift, and sagittal spinopelvic alignment.
RESULTS
There were 12 boys and 9 girls with a mean age of 6.5±3.2 years. The mean follow-up period was 6.7±1.3 years. The mean fusion level was 2.7±0.9 segments. The mean segmental scoliosis was 29±6 degrees preoperatively, 9±3 degrees (correction rate of 71%) postoperatively ( P <0.05), and 7±3 degrees (correction rate of 76%) at the latest follow-up. The compensatory curve of 26±12 degrees was spontaneously corrected to 14±8 degrees (correction rate of 47%) at last follow-up ( P <0.05). Trunk shift was significantly improved on both coronal (53%) and sagittal (56%) planes after surgery ( P 0.05) and stable at follow-up. The sagittal spinopelvic alignment was balanced in all cases. There were no neurological or infectious complications.
CONCLUSIONS
It is safe and effective to perform 1-stage posterior-only lumbosacral hemivertebra resection with short-segment fusion, which can significantly correct the segmental scoliosis, prevent the compensatory curve progress and improve the trunk shift. This strategy also can save motion segments and avoid long lumbar fusion. Medium-term and long-term follow-up outcomes are satisfactory.
LEVEL OF EVIDENCE
Level III.
背景
本研究的目的是评估儿童一期单纯后路腰骶半椎体切除联合短节段融合术的中期和长期手术效果。
方法
本回顾性病历研究纳入了21例因腰骶半椎体导致先天性脊柱侧凸的儿童，他们在2012年至2016年间接受了一期单纯后路半椎体切除联合短节段融合术，且随访时间至少为5年。对术前、术后及末次随访时的脊柱站立位前后位和侧位X线片进行比较。影像学评估包括测量节段性脊柱侧凸和前凸、代偿性脊柱侧凸、胸椎后凸、腰椎前凸、躯干偏移以及矢状面脊柱骨盆对线的变化。
结果
共有12例男孩和9例女孩，平均年龄为6.5±3.2岁。平均随访时间为6.7±1.3年。平均融合节段为2.7±0.9个。术前平均节段性脊柱侧凸为29±6度，术后为9±3度（矫正率71%）（P<0.05），末次随访时为7±3度（矫正率76%）。代偿性曲度术前为26±12度，末次随访时自发矫正至14±8度（矫正率47%）（P<0.05）。术后躯干偏移在冠状面（53%）和矢状面（56%）均有显著改善（P<0.05），随访时保持稳定。所有病例的矢状面脊柱骨盆对线均平衡。未出现神经或感染并发症。
结论
一期单纯后路腰骶半椎体切除联合短节段融合术安全有效，可显著矫正节段性脊柱侧凸，防止代偿性曲度进展并改善躯干偏移。该策略还可保留运动节段并避免长节段腰椎融合。中期和长期随访结果令人满意。
证据级别
三级。
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