刘福云;贺盼盼;夏冰;于洋;牛学强;董延召;陈小龙;

• 1:郑州大学第三附属医院小儿骨科

摘要(Abstract)：

[目的]回顾性比较分析两种手术方法对治疗半椎体所致的先天性脊柱侧凸及侧后凸畸形的效果。[方法]2000年2月~2010年8月,本院收治39例先天性脊柱侧凸及侧后凸的儿童患者,男24例,女15例;年龄3个月~14岁,平均3.1岁。分为2组,单纯切除组(组1),19例;后路半椎体切除加椎弓根螺钉内固定组(组2),20例。术后支具固定4~6个月,随访2~13年,平均3.5年。2组术前、术后及末次随访摄站立前后位和侧位X线片。通过X线片和临床物理检查评估手术前后患者的侧弯矫正、躯干平衡和失代偿情况。[结果]单纯切除组平均手术时间161 min,平均失血量103 ml;内固定组平均手术时间267 min,平均失血量546 ml。两组比较均有显著性差异(P<0.05)。单纯切除组术后及末次随访节段弯矫正率40.3%、59.4%,主弯相应的矫正率为29.7%、37.6%(P<0.05)。内固定组术后及末次随访节段弯及主弯Cobb角矫正率分别为64.43%、67.72%;56.71%、56.7%(P<0.05)。单切组2例术后随访发生矫形丢失,无感染、神经系统并发症及椎弓根骨折现象。[结论]对进展型半椎体畸形,在原发弯发展严重或代偿弯形成结构性弯之前,应早期进行后路半椎体切除应用或不用内固定治疗,后路半椎体切除加椎弓根螺钉内固定对矫正和控制先天性脊柱侧弯冠状面和矢状面畸形效果更好。

关键词(KeyWords)： 先天性脊柱侧凸;半椎体畸形;椎弓根螺钉;幼儿

Abstract:

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作者(Author): 刘福云;贺盼盼;夏冰;于洋;牛学强;董延召;陈小龙;

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参考文献(References)：

• [1]刘福云,司丕成,夏冰,等.后路半椎体切除治疗小儿先天性脊柱侧弯[J].中国矫形外科杂志,2005,133:165-169.
• [2]夏冰,刘福云,武慧玲,等.单纯半椎体切除治疗小儿先天性脊柱侧弯20例疗效观察[J].中国矫形外科杂志,2013,7:733-735.
• [3]Ruf M,Harms J.Posterior hemivertibra resection with transpedicular instrumentation:early correction in children aged 1 to 6 years[J].Spine(Phila Pa 1976),2003,28:2132-2138.
• [4]Peng XS,Chen LY,Zou XN.Hemivertebra resection and scoliosis correction by a unilateral posterior approach using single rod and pedicle screw instrumentation in children under 5 years of age[J].J Pediatr Orthop B,2011,20:397-403.
• [5]Wang SR,Zhang JG,Qiu GX,et al.Posterior hemivertebra resection with bisegmental fusion for congenital scoliosis:more than 3 year outcomes and analysis of unanticipated surgeries[J].Eur Spine J,2013,22:387-393.
• [6]Yaszay B,O’Brien M,Shufflebarger B,et al.Efficacy of hemivertebra resection for congenital scoliosis[J].Spine,2011,36:2052-2060.
• [7]Shimode M,Kojima T,Sowa K.Spinal wedge osteotomy by a single posterior approach for correction of severeand rigid kyphosis or kyphoscoliosis[J].Spine,2002,20:2260-2267.
• [8]Ranade A,Samdani AF,Williams R,et al.Feasibility and accuracy of pedicle screws in children younger than eight years of age[J].Spine(PhilaPa 1976),2009,26:2907-2911.