Zhiguo Zhou, Fan Liu, Yuanxue Lei, Xing Wu, Si Wang, Ruichen Li
Department of Orthopedics, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China.
Department of Rheumatology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, HUST, Wuhan, China.
Front Surg. 2023 Mar 23;10:1137675. doi: 10.3389/fsurg.2023.1137675. eCollection 2023.
To explore the feasibility of a minimally invasive spine surgery strategy for congenital cervicothoracic scoliosis.
From April 2022 to August 2022 in the hospital, three patients with torticollis and/or shoulder imbalance due to a cervicothoracic hemivertebra were performed on by hemivertebra resection and short fusion of the adjacent vertebrae. Resection was operated by a posterior approach. The average age of three patients of surgery was 8 years 2 months and the mean follow-up period was 6 months. Radiographic assessments and cosmetic outcomes were documented on changes in measurements of segmental scoliosis, neck tilt, head shift, shoulder balance, and sagittal profiles.
The mean operating time of the procedure was 283 min and the instrumentation density was 1.5 pedicle screws per vertebra. The mean estimated blood loss was 257 ml, which was 20% less than the data described in various literatures. The mean segmental Cobb angle at the cervicothoracic deformity was 35.9° before surgery, 20.7° after surgery, and 16.3° at the latest follow-up, with a correction rate of 54.59%. Neck tilt decreased from 17.3° before surgery to 14.3° after surgery, and 11.7° at the latest follow-up, with a correction rate of 32.37%. T1 tilt improved from 16.5° before surgery to 12.9° after surgery, and 7.6° at the latest follow-up, with a correction rate of 53.94%. The clavicle angle improved from 4.8° before surgery to 3.1° after surgery, and 1.9° at the latest follow-up, with a correction rate of 60.42%. Head shift improved from 21.4 mm before surgery to 9.2 mm after surgery, and 12.3 mm at the latest follow-up, with a correction rate of 42.52%. The correction of torticollis and shoulder asymmetry was achieved in all cases.
Minimally invasive spine surgery strategy may be an option for congenital cervicothoracic scoliosis. A good correction of cervicothoracic dissymmetry is achieved, accompanied by fewer pedicle screws and less blood loss. By deliberate operation in young kids, surgical intervention for severe compensatory curves can be prevented.
探讨先天性颈胸段脊柱侧凸微创脊柱手术策略的可行性。
2022年4月至2022年8月期间，对3例因颈胸半椎体导致斜颈和/或肩部失衡的患者进行了半椎体切除及相邻椎体短节段融合术。采用后路进行切除手术。3例手术患者的平均年龄为8岁2个月，平均随访时间为6个月。记录影像学评估和外观结果，包括节段性脊柱侧凸、颈部倾斜、头部偏移、肩部平衡和矢状面轮廓测量值的变化。
该手术的平均手术时间为283分钟，内固定密度为每椎体1.5枚椎弓根螺钉。平均估计失血量为257毫升，比各种文献报道的数据少20%。颈胸段畸形术前平均节段性Cobb角为35.9°，术后为20.7°，最近一次随访时为16.3°，矫正率为54.59%。颈部倾斜度从术前的17.3°降至术后的14.3°，最近一次随访时为11.7°，矫正率为32.37%。T1倾斜度从术前的16.5°改善至术后的12.9°，最近一次随访时为7.6°，矫正率为53.94%。锁骨角从术前的4.8°改善至术后的3.1°，最近一次随访时为1.9°，矫正率为60.42%。头部偏移从术前的21.4毫米改善至术后的9.2毫米，最近一次随访时为12.3毫米，矫正率为42.52%。所有病例均实现了斜颈和肩部不对称的矫正。
微创脊柱手术策略可能是先天性颈胸段脊柱侧凸的一种选择。实现了颈胸段不对称的良好矫正，同时椎弓根螺钉使用较少且失血量较少。通过对幼儿进行精心手术，可以避免对严重代偿性曲线进行手术干预。
