目的:比较儿童后路半椎体切除与短节段椎弓根螺钉内固定术治疗先天性脊柱侧凸(CS)的手术效果。
方法:回顾性分析2012-2018年在我院行后路半椎体切除及短节段双侧椎弓根螺钉内固定的30例CS患儿,分为对称固定组(n=18)和不对称固定组(n=12)。总的主曲线,分段主曲线,颅骨代偿曲线,尾代偿曲线,日冕平衡,在冠状平面上测量根尖椎骨的平移。节段性脊柱后凸,胸椎后凸,腰椎前凸,在矢状面测量矢状面平衡。
结果:在30个孩子中,切除28块半椎体。22个孩子有一个半椎骨,三个有两个半椎骨,五个是肋骨畸形。手术时间180~420min,平均268min。平均失血量为291mL(150-550mL)。随访12~47个月,平均21.1个月。对于对称固定组,包括总主曲线在内的术后和随访参数之间存在显着差异,分段主曲线,颅骨代偿曲线,尾代偿曲线,根尖椎体平移及节段后凸与术前参数比较(P<0.05)。术后冠状平衡显著低于术前冠状平衡(P<0.05)。术后随访胸椎后凸程度明显高于术前和术后胸椎后凸程度(P<0.05)。对于不对称固定组,术后和随访参数包括总主曲线,分段主曲线,颅骨代偿曲线,尾代偿曲线,根尖椎骨翻译,节段后凸与术前参数比较差异有统计学意义(P<0.05)。术后矢状面平衡明显高于术前(P<0.05)。两组术后及随访矫正率及矫正丢失率比较,差异均无统计学意义(P>0.05)。在我们的研究中,30名儿童出现了三种并发症,包括两个伤口愈合不良的病例,无菌换药半个月后伤口愈合顺利。1例T12和L3半椎体切除后出现术后曲线进展,再次计划胸半椎体切除。
结论:对于难以进行螺钉固定的椎弓根,可以选择相邻节段进行螺钉固定,对于未内固定的椎弓根≤3是安全有效的。
OBJECTIVE: To compare the surgical effect of children with symmetrical screw fixation and asymmetric screw fixation during posterior hemivertebra excision and short-segment pedicle screw fixation for the treatment of congenital scoliosis (CS).
METHODS: A total of 30 children with CS who underwent posterior hemivertebra excision and short-segment bilateral pedicle screw fixation in our hospital from 2012 to 2018 were retrospectively included and were divided into two groups: symmetric fixation group (n = 18) and asymmetric fixation group (n = 12). The total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, coronal balance, and apical vertebra translation were measured in the coronal plane. The segmental kyphosis, thoracic kyphosis, lumbar lordosis, and sagittal balance were measured in the sagittal plane.
RESULTS: Of the 30 children, 28 hemivertebrae were resected. Twenty-two children had one hemivertebra, three had two hemivertebrae, and five were rib deformities. The average operation time was 268 min (180-420 min). The average blood loss was 291 mL (150-550 mL). The average follow-up was 21.1 months (12-47 months). For symmetric fixation group and there were significant differences among postoperative and follow-up parameters including the total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, apical vertebra translation and segmental kyphosis compared with those of preoperative parameters (P < 0.05). The postoperative coronal balance was significantly lower than preoperative coronal balance (P < 0.05). The follow-up thoracic kyphosis was significantly higher than preoperative and postoperative thoracic kyphosis (P < 0.05). For asymmetric fixation group, the postoperative and follow-up parameters including the total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, apical vertebra translation, and segmental kyphosis had statistical differences compared with those of preoperative parameters (P < 0.05). The postoperative sagittal balance was significantly higher than preoperative postoperative (P < 0.05). There were no significant differences in the postoperative and follow-up correction rate and correction loss between the two groups (P > 0.05). There were three complications in 30 children in our study, including two cases who had poor wound healing, and the wound healed smoothly after half a month of sterile dressing change. Postoperative curve progression occurred in one case after T12 and L3 hemivertebra resection and thoracic hemivertebra resection was planned again.
CONCLUSIONS: For pedicles which were difficult for screw fixation, adjacent segments can be chosen for screw fixation and it is safe and effective for vertebral pedicles ≤3 without internal fixation.