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目的:评价后路半椎体切除、椎弓根螺钉内固定治疗小儿先天性脊柱畸形的临床疗效。方法:2003年6月～2005年6月应用后路半椎体切除、椎弓根螺钉内固定和自体骨短节段植骨融合治疗28例小儿先天性脊柱侧凸畸形患者,男10例,女18例,年龄1.6～7岁,平均3.8岁。完全分节半椎体24例,半椎体伴对侧分节障碍4例。术后定期复查脊柱X线片,观察脊柱融合、畸形矫正率及内固定稳定情况。结果:术中发生胸膜损伤和脑脊液漏各1例,分别经胸腔和伤口引流痊愈;术后切口浅表感染1例,经抗炎和换药处理治愈;无神经系统损伤。随访23～48个月,平均35个月,术前主弯冠状面Cobb角平均为35.2°±2.2°,术后为5.2°±1.2°,末次随访为7.4°±1.1°,丢失2.2°;后凸角平均为26.2°±3.1°,术后为4.2°±0.8°,末次随访为4.8°±1.0°,丢失0.6°;均获得良好骨融合,融合时间3～6个月,平均4.2个月;无内固定失败及假关节形成。结论:后路半椎体切除、椎弓根螺钉内固定植骨融合能安全有效地矫正小儿先天性脊柱侧凸畸形,并能达到稳定的短节段内固定及优良的融合效果。
Objective: To evaluate the clinical efficacy of posterior hemivertebra resection and pedicle screw fixation in the treatment of children with congenital spinal deformity. Methods: From June 2003 to June 2005, 28 cases of children with congenital scoliosis deformity were treated with posterior hemivertebra resection, pedicle screw fixation and autologous short segment bone graft fusion. There were 10 males and 10 females, 18 females, aged 1.6 to 7 years old, with an average of 3.8 years old. Complete segmental hemivertebra in 24 cases, hemivertebra with contralateral segmental disorders in 4 cases. Spine X-ray films were regularly reviewed after operation to observe spinal fusion, deformity correction and stability of internal fixation. Results: There were 1 case of pleural injury and cerebrospinal fluid leakage during operation, respectively, which were cured by thoracic cavity and wound drainage. One case was superficially infected by incision and cured by anti-inflammatory and dressing-changing treatment. There was no nervous system injury. All the patients were followed up for 23-48 months with an average of 35 months. The Cobb angle of preoperative coronal plane was 35.2 ° ± 2.2 ° and 5.2 ° ± 1.2 ° postoperatively. The final follow-up was 7.4 ° ± 1.1 ° with a loss of 2.2 °. The mean average length of kyphosis was 26.2 ° ± 3.1 °, postoperatively 4.2 ° ± 0.8 °, final follow-up was 4.8 ° ± 1.0 °, and loss of 0.6 °. All achieved good fusion with an average of 4.2 months Month; no internal fixation failure and pseudarthrosis. Conclusion: Posterior hemivertebra resection and pedicle screw fixation with internal fixation can safely and effectively correct congenital scoliosis deformity in children and achieve stable fixation of short segments and good fusion.