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目的:探讨骨桥切断、凹侧松解、半椎体切除治疗儿童轻中度混合型先天性脊柱侧后凸的效果。方法:2001年1月~2013年1月对32例椎体分节障碍混合椎体形成障碍的先天性脊柱侧后凸患儿行后路半椎体切除的同时,行凹侧骨桥切断、松解,利用椎弓根钉棒系统矫形。其中男10例,女22例;年龄4~12岁(7.8±4.2岁)。侧凸Cobb角58.3°±12.5°(35°~78°),后凸Cobb角47.6°±15.6°(13°~55°),躯干偏移18.2±5.5mm(11~32mm)。畸形位于T7~L3,顶椎位于胸段11例、胸腰段13例、腰段8例。合并脊髓纵裂3例,神经根囊肿1例,脊髓拴系综合征1例。结果:手术时间230±125min(160~270min),术中出血量590±113ml(310~850ml)。术中2例置钉过程中出现椎弓根骨折,调整固定节段后完成矫形。术后1例出现单侧下肢麻木无力,予甲强龙及脱水剂治疗1周后症状缓解;2例出现脑脊液漏。术后脊柱侧凸Cobb角13.8°±7.1°(5°~28°),矫正率(76.3±9.5)%;脊柱后凸15.1°±3.9°(0~20°),矫正率(68.3±11.2)%;躯干偏移距离3.1±2.3mm(0~11.6mm)。随访18.4±12.6个月(12~60个月),末次随访时侧凸矫正率丢失(3.9±1.6)%,后凸矫正率丢失(2.3±0.9)%,无内固定松动及断裂发生。结论:对儿童轻中度混合型先天性脊柱侧后凸畸形,行后路一期半椎体切除的同时,将凹侧分节障碍的骨桥予以切断、松解,再通过椎弓根钉棒系统矫形,可获得满意的矫形效果。
OBJECTIVE: To investigate the effect of osteotomy, concave lateral release and hemivertebra resection on children with mild to moderate congenital kyphosis. Methods: From January 2001 to January 2013, 32 cases of congenital kyphotic kyphosis with congenital vertebral segmental vertebral segmental congenital dysfunction were treated by posterior hemivertebra resection, Release, the use of pedicle screw system orthopedic. Including 10 males and 22 females; aged 4 to 12 years (7.8 ± 4.2 years). Scoliosis Cobb angle of 58.3 ° ± 12.5 ° (35 ° ~ 78 °), kyphotic Cobb angle of 47.6 ° ± 15.6 ° (13 ° ~ 55 °), torso offset 18.2 ± 5.5mm (11 ~ 32mm). Deformity in T7 ~ L3, apex in the thoracic in 11 cases, thoracolumbar in 13 cases, lumbar in 8 cases. 3 cases of combined longitudinal spinal cord, nerve root cyst in 1 case, tethered cord syndrome in 1 case. Results: The operation time was 230 ± 125min (160 ~ 270min). The intraoperative blood loss was 590 ± 113ml (310 ~ 850ml). During operation, 2 cases of pedicle screw fracture occurred, after adjusting the fixation segment to complete the orthosis. One case of postoperative unilateral lower extremity numbness, to methylprednisolone and dehydration agent symptoms after 1 week of treatment; 2 cases of cerebrospinal fluid leakage. The Cobb angle of postoperative scoliosis was 13.8 ° ± 7.1 ° (ranged from 5 ° to 28 °) and the correction rate was 76.3 ± 9.5%. The kyphosis ranged from 15.1 ° ± 3.9 ° to 0 ° to 20 °. The correction rate was 68.3 ± 11.2% )%; Trunk offset distance 3.1 ± 2.3mm (0 ~ 11.6mm). The follow-up was 18.4 ± 12.6 months (range, 12 to 60 months). At the final follow-up, the correction rate of scoliosis was 3.9 ± 1.6%, and the correction rate of kyphosis was 2.3 ± 0.9%. There was no loosening or rupture of internal fixation. Conclusion: In children with mild to moderate congenital kyphotic deformity congenital kyphosis, a posterior hemivertebra resection at the same time, the concave lateral segmental disorder of the bone bridge to be cut off, release, and then through the pedicle screw Rod system orthopedic, to obtain satisfactory orthopedic effect.