Xia Bing, Wang Hongqian, Dong Yingmei, Liu Fuyun, Wang Wenjing, Hu Weiming, Wang Feipeng, Ma Fengqun, Wang Kai
Department of Pediatric Orthopedics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Front Surg. 2023 Jan 6;9:1018061. doi: 10.3389/fsurg.2022.1018061. eCollection 2022.
To retrospectively analyze the feasibility and efficacy of posterior hemivertebra resection without internal fixation in the treatment of congenital scoliosis in very young children.
Sixteen cases of very young children with congenital scoliosis treated at our hospital from April 2000 to July 2019 were collected, including 8 cases of each sex, all of whom had type I/III congenital scoliosis and were operated on at a median (interquartile range) of 9.00 (7.75) months (range, 0.5-48 months) of age. All cases underwent posterior hemivertebra resection without internal fixation and wore orthopedic braces or plaster undershirts for more than six months after surgery, with a mean follow-up of 94.31 ± 65.63 months (range, 36-222 months).
Coronal plane: the preoperative Cobb angle for the segmental curve was 39.50 ± 9.70° compared to postoperative (19.19 ± 8.56°) and last follow-up (14.94 ± 12.11°) (both < 0.01); the preoperative Cobb angle for the main curve was 34.19 ± 14.34° compared to postoperative (17.00 ± 11.70°) and last follow-up (17.56 ± 16.31°) (both < 0.01); the preoperative Cobb angle of the proximal compensated curve was 14.88 ± 9.62° compared to postoperative (7.88 ± 4.66°) and last follow-up (8.38 ± 8.36°) (both < 0.05); and the preoperative Cobb angle of the distal compensated curve was 13.50° (10.50°) (range, 4°-30°) compared with postoperative 4.50° (9.25°) (range, -3° to 25°) and final follow-up 5.50° (9.50°) (range, -3° to 33°) (both < 0.01). Sagittal plane: the difference in the preoperative Cobb angle was 10.00° (14.00°) (range, -31° to 41°) for segmental kyphosis compared to postoperative 14.00° (24.50°) (range, -6° to 46°) and last follow-up 17.00° (22.55°) (range, -40° to 56°), and these were not statistically significant (both > 0.05). There was a tendency for the thoracolumbar kyphosis to worsen and the lumbosacral kyphosis to improve during the follow-up period.
Posterior hemivertebra resection without internal fixation is a feasible treatment for type I/III congenital scoliosis in very young children, but the correction of the sagittal deformity of the thoracolumbar spine is not satisfactory, and postoperative external fixation may require further improvement.
回顾性分析后路半椎体切除术不进行内固定治疗极低龄儿童先天性脊柱侧凸的可行性和疗效。
收集2000年4月至2019年7月在我院接受治疗的16例极低龄先天性脊柱侧凸患儿，男女各8例，均为I/III型先天性脊柱侧凸，手术年龄中位数（四分位间距）为9.00（7.75）个月（范围0.5 - 48个月）。所有病例均接受后路半椎体切除术且不进行内固定，术后佩戴矫形支具或石膏背心6个月以上，平均随访94.31±65.63个月（范围36 - 222个月）。
冠状面：节段性曲线术前Cobb角为39.50±9.70°，术后为（19.19±8.56°），末次随访为（14.94±12.11°）（两者均<0.01）；主曲线术前Cobb角为34.19±14.34°，术后为（17.00±11.70°），末次随访为（17.56±16.31°）（两者均<0.01）；近端代偿曲线术前Cobb角为14.88±9.62°，术后为（7.88±4.66°），末次随访为（8.38±8.36°）（两者均<0.05）；远端代偿曲线术前Cobb角为13.50°（10.50°）（范围4° - 30°），术后为4.50°（9.25°）（范围 - 3°至25°），末次随访为5.50°（9.50°）（范围 - 3°至33°）（两者均<0.01）。矢状面：节段性后凸术前Cobb角差异为10.00°（14.00°）（范围 - 31°至41°），术后为14.00°（24.50°）（范围 - 6°至46°），末次随访为17.00°（22.55°）（范围 - 40°至56°），差异无统计学意义（两者均>0.05）。随访期间胸腰段后凸有加重趋势，腰骶段后凸有改善趋势。
后路半椎体切除术不进行内固定是治疗极低龄儿童I/III型先天性脊柱侧凸的一种可行方法，但胸腰椎矢状面畸形的矫正效果不理想，术后外固定可能需要进一步改进。
