Department of Orthopedics, Children's Hospital of Fudan University, National Children's Medical Center, Wan Yuan Road, Shanghai, 201102, China.
BMC Musculoskelet Disord. 2024 Aug 15;25(1):646. doi: 10.1186/s12891-024-07764-9.
Although early hemivertebra (HV) resection and short fusion (within 4 segments) have been successful in treating congenital HV, there is limited research comparing the outcomes of the shortest-segment fusion (2 segments) versus 3 or 4 segments, particularly in young children. To evaluate the efficacy of posterior hemivertebrectomy combined with two or more segments fusion in children under the age of 10 years with a solitary simple lower thoracic or lumbar HV (T8-L5).
This retrospective study included patients under the age of 10 with lower thoracic or lumbar solitary simple HV who underwent hemivertebra resection (HVR) and transpedicular short fusion and were divided into HV ± 1 group (2 segment fusion) and HV ± 2 group (3 or 4-segment fusion). The study recorded preoperative, postoperative (1 week), and the latest follow-up radiographic parameters and complications. The results of the coronal and sagittal planes were analyzed, and the main curve, segmental scoliosis curve, compensatory scoliosis curve, segmental kyphosis curve, and trunk shift were compared.
The study included 35 patients (15 in the HV ± 1 group and 20 in the HV ± 2 group) with a mean age of 5.26 ± 2.31 years and a mean follow-up of 22.54 months (12-68). The mean preoperative Cobb angle was 32.66° ± 7.339° (HV ± 1) and 29.31°±6.642° (HV ± 2). The final Cobb angle was 10.99°± 7.837° (HV ± 1) and 8.22° ± 4.295° (HV ± 2). The main curve corrected by 72% (HV ± 1), 75% (HV ± 2) postoperatively and 67% (HV ± 1), 72% (HV ± 2) at the final follow-up (P > 0.05). There were no significant differences in the correction of the segmental scoliosis curve, compensatory scoliosis curve, segmental kyphosis curve, and trunk shift between the HV ± 1 and HV ± 2 groups (P > 0.05). The unplanned reoperation rate for HV in the thoracolumbar region (T11-L2) is significantly higher (P = 0.038).
In the context of solitary simple lower thoracic or lumbar HV (T8-L5), HV ± 1 segment fusion suffices and yields comparable correction outcomes in the midterm period when compared to HV ± 2. The reoperation rate exhibited a statistically significant increase in the thoracolumbar region.
尽管早期半椎体（HV）切除和短节段融合（4 节段内）已成功用于治疗先天性 HV，但比较最短节段融合（2 节段）与 3 或 4 节段融合的结果的研究有限，尤其是在幼儿中。本研究旨在评估后路半椎体切除术联合 2 个或更多节段融合治疗年龄在 10 岁以下、单一简单下胸段或腰段 HV（T8-L5）的疗效。
本回顾性研究纳入了年龄在 10 岁以下、单一简单下胸段或腰段 HV 且接受半椎体切除（HVR）和经椎弓根短节段融合的患者，将其分为 HV ± 1 组（2 个节段融合）和 HV ± 2 组（3 或 4 个节段融合）。研究记录了术前、术后（1 周）和末次随访的影像学参数和并发症。分析冠状面和矢状面的结果，比较主弯、节段脊柱侧凸曲线、代偿性脊柱侧凸曲线、节段后凸曲线和躯干移位。
研究纳入了 35 名患者（HV ± 1 组 15 名，HV ± 2 组 20 名），平均年龄为 5.26 ± 2.31 岁，平均随访时间为 22.54 个月（12-68 个月）。术前 Cobb 角平均为 32.66° ± 7.339°（HV ± 1）和 29.31°±6.642°（HV ± 2）。末次随访时 Cobb 角分别为 10.99°± 7.837°（HV ± 1）和 8.22° ± 4.295°（HV ± 2）。术后主弯矫正率为 72%（HV ± 1）、75%（HV ± 2），末次随访时为 67%（HV ± 1）、72%（HV ± 2）（P>0.05）。HV ± 1 组和 HV ± 2 组之间节段性脊柱侧凸曲线、代偿性脊柱侧凸曲线、节段后凸曲线和躯干移位的矫正均无显著差异（P>0.05）。胸腰段（T11-L2）HV 计划性再手术率显著升高（P=0.038）。
在单一简单下胸段或腰段 HV（T8-L5）的情况下，HV ± 1 节段融合足以获得与 HV ± 2 相当的中期矫正结果。胸腰段的再手术率有显著增加。
