目的探讨后路病椎切除、经椎弓根内固定治疗儿童及青少年先天性脊柱侧后凸畸形的方法选择,评价其临床效果。方法2003年5月-2007年12月,收治28例先天性脊柱侧凸和后凸畸形患者。其中男11例,女17例;年龄1.5～17.0岁,平均9.6岁。病椎位于胸段13例,胸腰段10例,腰段5例。依据病椎类型及畸形范围,采取不同经后路病椎切除方式:半椎体切除(13例)、半椎体切除联合对侧分节不全切除(7例)、全脊椎切除(8例)。均依靠椎弓根螺钉器械行矫形内固定术,其中短节段固定7例(A组),长节段固定、单纯半椎体或联合对侧骨桥切除13例(B组),长节段固定、全脊椎切除8例(C组)。记录各组患者手术时间及出血量,测量侧凸及后凸角度并计算矫正率。结果A、B、C组手术时间分别为(98±17)、(234±42)、(383±67)min,出血量分别为(330±66)、(1540±120)、(4760±135)mL,3组间比较差异均有统计学意义(P<0.05)。术后患者切口均Ⅰ期愈合,无深部感染、呼吸衰竭或深静脉血栓等并发症发生。1例C组患者于术后6h出现脊髓再灌注损伤,经积极治疗后2周恢复正常;余患者无神经系统并发症发生。28例均获随访,随访时间24～72个月,平均32.8个月。影像学资料示术后6个月植骨融合良好,有连续性骨性结构连接病椎切除后间隙,手术所获矫形角度无明显丢失。所有患者无螺钉松动或拔钉等现象发生。术后2周X线片示3组侧凸及后凸角度与术前比较差异均有统计学意义(P<0.01)。A、B组侧凸矫正率显著高于C组(P<0.05),A、B组间差异无统计学意义(P>0.05);A、C组后凸矫正率低于B组(P<0.05),A、C组间差异无统计学意义(P>0.05)。结论后路病椎切除可直接去除致畸因素,在冠状面和矢状面均可获得良好的矫形,手术计划应结合患者年龄,针对不同的致畸因素及畸形情况,选择恰当的手术方式及固定范围。 Objective To evaluate the clinical efficacy of posterior approach debridement and pedicle screw fixation in the treatment of congenital kyphotic deformity in children and adolescents. Methods From May 2003 to December 2007, 28 patients with congenital scoliosis and kyphosis were treated. Including 11 males and 17 females; aged 1.5 to 17.0 years, mean 9.6 years. Diseases in thoracic vertebra 13 cases, thoracolumbar 10 cases, lumbar 5 cases. According to the type and deformity of the diseased vertebrae, different methods of posterior debridement were adopted: hemivertebra excision (13 cases), hemivertebra resection combined with contralateral segmental partial resection (7 cases), total spondylectomy (8 cases) . All underwent pedicle screw instrumentation and orthopedic fixation. Among them, 7 cases (group A) with short segment fixation, 13 cases (group B) with long segment fixation, simple hemivertebra or united contralateral bone bridge, Segment fixed, total spondylotomy in 8 cases (C group). The operation time and blood loss of each group were recorded, the angle of scoliosis and kyphosis were measured, and the correction rate was calculated. Results The operative time of group A, B and C were (98 ± 17), (234 ± 42) and (383 ± 67) min, respectively. The bleeding volume was 330 ± 66, 1540 ± 120 and 4760 ± 135, ) mL, the difference between the three groups was statistically significant (P <0.05). Postoperative incision healed by first-degree, no deep infection, respiratory failure or deep venous thrombosis and other complications occurred. One patient in group C showed spinal cord reperfusion injury at 6h after operation, and returned to normal after two weeks of active treatment. No neurologic complications occurred in the remaining patients. 28 cases were followed up for 24 to 72 months, an average of 32.8 months. Imaging data showed that 6 months after surgery, there was a good fusion of the bone graft and bone, and a continuous osseous structure was used to connect the space after the resection of the diseased vertebrae. There was no obvious loss of the orthopedic angle. All patients without screws loose or pulling the nail phenomenon. There were significant differences in the angles of scoliosis and kyphosis between the two groups at 2 weeks after operation (P <0.01). The correction rate of scoliosis in group A and group B was significantly higher than that in group C (P <0.05), and there was no significant difference between group A and group B (P> 0.05). The correction rate of group A and group C was lower than that in group B (P < 0.05). There was no significant difference between A and C groups (P> 0.05). Conclusions The posterior pathological resection of the vertebral body can directly remove the causes of teratogenicity and obtain good orthosis in the coronal and sagittal planes. The surgical plan should be based on the age of the patient, according to different teratogenic factors and deformity, select the appropriate surgical methods and Fixed range.