Zidorn T, Krauspe R, Eulert J
Department of Orthopaedic Surgery, University of Würzburg, Germany.
Spine (Phila Pa 1976). 1994 Nov 1;19(21):2456-60. doi: 10.1097/00007632-199411000-00017.
Only small numbers patients with dorsal hemivertebrae have been reported. The natural course of this disease remains unpredictable, especially regarding the development of neurologic impairment. Two children with congenital dorsal hemivertebra with progressive kyphosis of the lumbar spine are presented. Onset and method of treatment are discussed.
Two boys with kyphosis due to dorsal hemivertebrae of the lumbar spine were followed with clinical examination, anteroposterior roentgenograms, and magnetic resonance imaging. One patient was in follow-up for more than 4 years postoperatively. The other patient, who has not undergone surgery, has been in follow-up for more than 2 years, undergoing reassessment every 4 to 6 months.
Spastic paralysis developed in one patient with dorsal hemivertebra and spina bifida. The other patient with dorsal hemivertebra and sacral agenesis had no neurologic deficit.
A dorsal approach with resection of the dorsal hemivertebra and short dorsal fusion with internal fixation was done in one patient. The other patient underwent clinical and radiologic follow-up. Method and onset of surgical treatment were compared with other studies.
Progressive spasticity was seen in our first patient. This could be reversed by resection of the hemivertebra and monosegmental fusion. Alignment of the spine and normalization of the width of spinal canal were achieved. The second patient has not had a neurologic problem. Surgical treatment will be performed when indicated.
A posterior approach is recommended for a dorsal hemivertebra. Decompression of the spinal canal can be achieved by resection of the dorsal hemivertebra and short dorsal fusion with internal fixation. Surgery should be done early to avoid late neurologic impairment.
仅有少数关于胸椎半椎体患者的报道。该疾病的自然病程仍不可预测，尤其是在神经功能障碍的发展方面。本文介绍了两名患有先天性胸椎半椎体并伴有腰椎进行性后凸的儿童。讨论了发病情况及治疗方法。
对两名因腰椎胸椎半椎体导致后凸的男孩进行临床检查、前后位X线片及磁共振成像随访。一名患者术后随访超过4年。另一名未接受手术的患者已随访超过2年，每4至6个月进行一次重新评估。
一名患有胸椎半椎体和脊柱裂的患者出现了痉挛性瘫痪。另一名患有胸椎半椎体和骶骨发育不全的患者没有神经功能缺损。
对一名患者采用后路手术切除胸椎半椎体并进行短节段后路融合内固定。另一名患者接受临床和影像学随访。将手术治疗的方法和时机与其他研究进行比较。
我们的第一名患者出现了进行性痉挛。通过切除半椎体和单节段融合，这种情况可以得到改善。实现了脊柱的对线和椎管宽度的正常化。第二名患者没有出现神经问题，如有指征将进行手术治疗。
对于胸椎半椎体，建议采用后路手术。通过切除胸椎半椎体和短节段后路融合内固定可实现椎管减压。手术应尽早进行，以避免晚期神经功能障碍。
