早期半椎体切除Apofix椎板钩加压固定治疗小儿完全分节型半椎体畸形

[目的]介绍早期半椎体切除Apofix椎板钩加压固定治疗小儿完全分节型半椎体畸形的手术方法并对其治疗效果进行评价。[方法]对5例先天性完全分节型半椎体畸形患儿的治疗经过及结果进行回顾性随诊分析。[结果]5例半椎体均切除充分,术后侧凸和后凸Cobbs角较术前平均减少12.5°。随访8个月～2a6个月,侧凸和后凸畸形矫正满意。[结论]早期半椎体切除并Apofix椎板钩加压固定是治疗小儿非对称性完全分节型半椎体畸形简单有效的方法。     

先天性半椎体脊柱侧凸畸形的手术治疗

目的探讨治疗青少年先天性半椎体脊柱侧凸畸形的手术方法及治疗效果。方法对19例先天性半椎体脊柱侧凸患者，按照术式分为前路半椎体切除、短节段固定；前路切除半椎体、后路切除残余半椎体的关节突、椎板、矫形固定；后路半椎体切除、矫形固定。结果19例患者中侧凸平均矫正角度35．4°，矫正率63％，经6～24个月随访，2例出现交界区“附加”现象，其余病例半椎体切除区骨愈合良好，无断棒、脱钩等并发症，达到满意的矫形效果。结论小儿半椎体畸形应早期手术治疗。     

经后路手术切除内固定矫正治疗先天性半椎体畸形

目的回顾性分析4例由先天性半椎体造成的脊柱侧弯和后凸畸形经后路一次半椎体切除植骨固定矫正术的手术治疗效果。方法4例患者，半椎体的位置均在胸腰段，手术采用后路切口，切除半椎体后，内固定矫正畸形，植骨融合，术后平均随访时间为12月，术前、术后拍摄站立位的脊柱正侧位片。结果所有患者均有不同程度的侧弯和后凸畸形，侧弯角由术前的34^o矫正至11^o，后凸角由术前18^o矫正至6^o，躯干位移从15mm恢复至5mm，无任何手术并发症，无内固定断裂脱落，均融合。结论此手术方法对患有半椎体导致先天性脊柱畸形的患儿是有效、安全的方法。     

早期后路半椎体切除治疗小儿非对称性半椎体畸形

目的:探讨早期后路半椎体切除治疗小儿非对称性半椎体畸形的效果。方法:采用后路半椎体切除治疗小儿非对称性半椎体畸形33例,随诊术后脊柱的生长发育、功能活动及X线摄片情况。结果:1例半椎体切除不全者残存的椎体继续生长,导致脊柱侧凸畸形加重48°,其余32例脊柱畸形有不同程度的减轻,脊柱的生长发育和功能活动正常。结论:早期后路半椎体切除是治疗小儿非对称性半椎体畸形的有效方法。     

青少年先天性半椎体脊柱侧凸畸形的手术治疗

[目的]探讨治疗青少年先天性半椎体脊柱侧凸畸形的手术方法及治疗效果。[方法]对18例青少午先天性半椎体脊柱侧凸患者,按照术式分为侧前路矫正、前后路联合矫正。首先通过胸腰段、腰段脊柱侧凸的半椎体、椎间盘切除,然后采用侧前路短节段椎体螺钉固定,旋转棒的三维旋转矫正脊柱的畸形7例;采用前后路联合入路,经后路行残余半椎体的关节突、椎板切除,凸侧加压、凹侧支撑固定11例。[结果]18例患者中侧凸平均矫正Cobb's角36.7°,矫正率77%,经18~28个月随访,达到满意的矫形效果,丢失率低,融合良好。[结论]小儿半椎体畸形应早期手术治疗。侧前路和前、后路联合半椎体切除临床效果满意,其中前路矫正手术用于胸腰椎、腰椎单一半椎体畸形。     

半椎体切除治疗先天性脊柱侧弯畸形的手术配合

目的探讨后路半椎体切除治疗先天性脊柱侧弯畸形的手术配合体会。方法回顾性分析13例由半椎体病变引起脊柱侧弯畸形的患儿,其中,男10例,女3例。行后路半椎体切除、矫形内固定及植骨融合的手术配合方法。结果 13例手术均顺利完成,术后矫形效果满意,无一例因手术配合不当而影响手术质量。结论脊柱后路半椎体切除,椎弓根钉棒系统矫形内固定和植骨融合手术治疗先天性脊柱侧弯及矫正青少年脊柱结构性畸形达到了满意的效果。     

半椎体切除治疗儿童先天性脊柱侧弯疗效分析

[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414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4⁶个月,随访26个月,随访2¹3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。     

单一后路半椎体切除结合椎间融合器治疗先天性脊柱畸形

目的探讨经单纯后路半椎体切除结合椎间融合器在先天性脊柱畸形治疗中的应用及疗效。方法 2009年6月至2010年12月,6例先天性脊柱畸形患者行单纯后路半椎体切除,切除区域植入椎体间融合器,以此为支点,行后路椎弓根钉棒系统矫形,矫形区域行椎体间及后外侧融合。术后经过平均近12个月的随访。对术中出血、围手术期并发症、术后患者的影像学表现、临床症状等进行随访和评价。结果所有患者围手术期中均未发生血管、神经损伤等严重并发症。术后即刻影像学检查见半椎体切除彻底,脊柱侧后凸畸形矫正满意。随访中未见内固定失败及矫形丢失现象。结论后路切除半椎体畸形后,在缺损区域植入椎体间融合器,既可以帮助术中矫形,又可促进手术区域的融合和矫形的保持,减少假关节的发生和内固定的失败。     

经后路一次切除半椎体治疗先天脊柱畸形

目的　回顾性分析 9例由先天性半椎体造成的脊柱侧弯和后凸畸形经后路一次半椎体切除植骨固定矫正术的手术治疗效果。方法　 9例患者 ,半椎体的位置在胸腰段或腰椎 ,手术采用后路切口 ,切除半椎体后 ,内固定矫正畸形 ,植骨融合 ,术后平均随访时间为 2 0 .6月 ,术前、术后拍摄站立位的脊柱正侧位片。结果　所有患者均有不同程度的侧弯和后凸畸形 ,侧弯角由术前的 37.7°矫正至 10° ,后凸角由术前 30 .5°矫正至 6°,躯干位移从 2 3mm恢复至 5mm ,无任何手术并发症 ,无内固定断裂脱落 ,均融合。结论　此手术方法对发育前期的患儿且半椎体位于胸腰椎或腰椎造成的先天性脊柱畸形 ,是一有效、安全的方法。     

后侧半椎体切除治疗先天性角状脊柱后凸

[目的]介绍先天性后侧半椎体切除术的适应证和手术方法.[方法]经后路暴露双侧的椎板,自双侧分离暴露关节突外侧和横突,切除横突沿椎弓根自骨膜下向前分离,暴露多余的后侧半椎体,切除多余的一节椎弓和后侧半椎体,自后路行双侧椎弓根螺钉加压棒固定.[结果]手术治疗先天性后侧半椎体畸形35例,取得优异的治疗效果,但手术操作比较复杂,相当于全脊柱截骨术的难度.[结论]先天性后侧半椎体切除术的年龄范围:8～25岁,年龄越大越趋向于作全脊柱截骨术.     

Two-stage corrective surgery for congenital deformities of the spine.

Sixty patients with congenital deformities of the spine were operated upon in the past fifteen years using a two-stage procedure. In the fifty patients with scoliosis half of the deformities were due to hemivertebrae and half to unilateral bars. The average correction of the deformity was 47 per cent. Early neurological signs observed in two patients with a diastematomyelia resolved. Of the ten patients with kyphosis nine had neurological signs of impending paraplegia and one was completely paraplegic before operation; all improved markedly. Posterior spinal fusion alone in the rapidly progressing congenital deformity may not prevent further progression, particularly in those cases iwth unilateral bars. Anterior resection of the vertebral body with later posterior fusion with Harrington instrumentation is safe and effective.     

Excision and short segment fusion of a double ipsilateral lumbar hemivertebrae associated with a diastematomyelia and fixed pelvic obliquity

We report the surgical treatment course of a 4-year-old girl with congenital scoliosis, diastematomyelia and double adjacent hemivertebrae. She had a lumbar curve with an apparent pelvic obliquity. Simultaneous excision of double segmented sequential hemivertebra at the L3–L4 level and fusion with short-segment instrumentation was performed via a posterior approach. Intraoperative radiographs revealed satisfactory curve correction and 0° pelvic obliquity. Following the excision of double adjacent hemivertebrae, three adjacent nerve roots were placed in one intervertebral foramen bilaterally. Nevertheless, no neurological deficit was developed, and the patient was able to ambulate with a brace at day one. Pelvic balance and deformity correction were maintained with no implant failure at the fifth year follow-up. Excision of two ipsilateral adjacent hemivertebra and short-segment posterior fusion performed via posterior-only approach simultaneously is an effective, safe, and less invasive technique for the treatment of the described case.     

Surgical treatment of congenital kyphosis

STUDY DESIGN: In this study, 26 cases of congenital kyphosis and kyphoscoliosis treated surgically were retrospectively reviewed. OBJECTIVE: To assess the clinical outcomes and surgical indications for posterior only versus anteroposterior surgery in the child. SUMMARY OF BACKGROUND DATA: Congenital kyphosis usually is progressive without surgical intervention. Current recommended treatment includes posterior arthrodesis for deformities of less than 50 degrees to 60 degrees, and anterior release or decompression, anterior fusion, and posterior instrumented arthrodesis for large deformities and cord compression. METHODS: Cases involving myelodysplasia, spinal dysgenesis, and skeletal dysplasia were excluded from the study. Kyphoscoliosis was included if the kyphotic deformity was greater than the scoliotic deformity. Patients were grouped by age and surgical technique. The patients in group P1 underwent posterior arthrodesis at an age younger than 3 years, and those in group P2 underwent the procedure at an age older than 3 years. The patients in group AP1 underwent anterior and posterior procedures at an age younger than 3 years, and those in group AP2 underwent the procedures at an age older than 3 years. The preoperative deformity, complications, and postoperative deformity correction were analyzed. There were nine Type 1 (failure of formation), nine Type 2 (failure of segmentation), and eight Type 3 (mixed) deformities. Four patients had associated spinal dysraphism. Three patients with Type 1 deformities had clinical or radiographic evidence of cord compression. RESULTS: In Group P1, five patients at an average age of 16 months underwent posterior arthrodesis alone for an average kyphotic deformity of 49 degrees. The immediate postoperative correction improved over a period of 6 years and 9 months by an additional 10 degrees, resulting in a final deformity of 26 degrees. Pseudarthrosis developed in two patients, requiring fusion mass augmentation or anterior arthrodesis. Neither patient was instrumented. In Group P2, five patients at an average age of 13 years and 7 months underwent posterior arthrodesis with instrumentation for kyphotic deformity of 59 degrees. Approximately 30 degrees of intraoperative correction was achieved safely using compression instrumentation and positioning. No further correction occurred with growth. The final residual kyphotic deformity was 29 degrees after a follow-up period of 4 years and 5 months. In Group AP1, seven patients underwent anterior release or vertebra resection for deformity correction and posterior arthrodesis for an average kyphotic deformity of 48 degrees at the age of 16 months. There were no iatrogenic neurologic injuries. The final residual kyphotic deformity was 22 degrees after a follow-up period of 6 years and 3 months. In Group AP2, nine patients underwent anterior release or decompression with posterior arthrodesis for kyphotic deformity of 77 degrees at the age of 11 years and 6 months. The deformity was corrected to 37 degrees, with no significant loss over a follow-up period of 5 years and 2 months. There were two postoperative neurologic complications. CONCLUSIONS: After reviewing their experience, the authors made the following observations: 1) The pseudarthrosis rate was low even without routine augmentation of fusion mass if instrumentation was used; 2) gradual correction of kyphosis may occur with growth in patients younger than 3 years with Types 2 and 3 deformities after posterior fusion, but appears to be unpredictable; 3) the risk of neurologic injury with anterior and posterior fusion for kyphotic deformity was associated with greater age, more severe deformity, and preexisting spinal cord compromise.     

The timing of spinal fusion in adolescent idiopathic scoliosis

102 cases of idiopathic adolescent scoliosis seen over a period of 5 years were studied. 59 patients who were treated surgically and followed up for a minimum of 48 months, fell into one of two groups: Group I - those operated on within 3 years following the adolescent growth spurt, and Group II - those who were operated on at or after skeletal maturity. 35 patients were treated by Harrington instrumentation and posterior fusion and 24 by Harrington instrumentation, segmental sublaminar wiring and posterior fusion. In 7 patients anterior release was performed initially. In Group I, the extent of deformity correction and elimination of the rib hump were better, and complications such as neurological deficit, hook dislodgement and implant breakage were encountered less frequently. Harrington instrumentation, segmental sublaminar wiring and posterior fusion gave better results than instrumentation and fusion. Our results suggest that surgical correction should be done within 3 years following growth spurt, i.e. 14 to 16 years of age.     

Treatment of congenital scoliosis with single-level hemivertebrae

Introduction  The natural history of congenital scoliosis with hemivertebrae is unpredictable and the management is also controversial. Materials and methods  Between 1986 and 2004, 22 patients (eight male and fourteen female, mean 19.3 years old) with single-level hemivertebrae related congenital scoliosis underwent non-operative or operative treatment at our institution with an average follow-up period of 8.8 years. Results  Only a 5° curve progression was noted in upper thoracic hemivertebrae after followed up 6 years. By one stage combined anterior hemivertebrae excision, posterior instrumentation, and arthrodesis, up to 61% curve correction can be achieved. Posterior instrumentation, correction and arthrodesis showed a 25% correction. The result of pain relief is promising in skeletal-matured patients. Conclusions  Surgical instrumentation, correction and arthrodesis showed good results. The optimal treatment of choice may differed from one to the other.     

Hemivertebra resection in congenital scoliosis -- early correction in young children

BACKGROUND: Congenital scoliosis due to hemivertebrae usually progresses during further growth and leads to severe deformities. Early correction in young children is therefore required. PATIENTS: Thirty-six hemivertebrae in 33 children aged 1 to 6 years (average 3 years 5 months) underwent surgical intervention. Mean follow-up was 4.5 years (2 months to 13 years). METHODS: The hemivertebra was resected by a posterior approach. The gap after resection was closed by compression via a transpedicular instrumentation, thus correcting the scoliotic deformity. RESULTS: Mean Cobb angle of the main curve was 45.9 degrees preoperatively, 11.9 degrees postoperatively, and 9.9 degrees at latest follow-up. The compensatory cranial curve improved spontaneously from 18.4 degrees preoperatively to 5.0 degrees postoperatively and 3.7 degrees at latest follow-up. The compensatory caudal curve improved from 21.3 degrees to 6.7 and 5.4 degrees. The angle of kyphosis was 22.8 degrees preoperatively, 8.9 degrees postoperatively, and 6.8 degrees at latest follow-up. There was one infection, 2 pedicle fractures, and 3 implant failures. In 3 patients additional operations were performed due to new developing deformities. CONCLUSION: Correction surgery of congenital scoliosis should be performed early before the development of severe local deformities and secondary structural changes. Posterior resection of the hemivertebrae with transpedicular instrumentation allows for early intervention in very young children. Excellent correction in both the frontal and sagittal planes, and a short segment of fusion allow for normal growth in the unaffected parts of the spine.     

Adolescent scar contracture scoliosis caused by back scalding during the infantile period

The study design was a retrospective study in adolescent scar contracture scoliosis caused by back scalding during the infantile period. The objective of the study was to investigate the pathogenesis, clinical manifestation and treatment of adolescent scar contracture scoliosis caused by back scalding during the infantile period. This condition seldom occurs and is not reported in current English literature. One patient was first treated with skin expansion, back scar excision and skin flap transfer, followed by anterior correction with TSRH instrumentation. Two patients were first treated with back scar excision and anterior spinal release. One patient was treated with posterior correction with TSRH instrumentation, and thoracoplasty was performed after 50 days in halo-wheelchair traction. The other patient was treated with posterior correction with TSRH instrumentation. No management of scalding was performed on the fourth patient. Anterior release and posterior correction were performed at an interval of 3 weeks. The deformities of four patients were well corrected. Trunk balance was restored and the pelvis leveled. The skin incision wounds healed well. Minor loss of correction was recorded during the last follow-up. Severe scar contracture caused by back scalding during the infantile period could lead to adolescent scoliosis. Its pathogenesis and clinical manifestation are different from the typical adolescent idiopathic scoliosis. The treatment of this kind of scoliosis should be individualized. The research was approved by the Ethics Committee of Nanjing University.     

A three-dimensional radiographic comparison of Cotrel-Dubousset and Colorado instrumentations for the correction of idiopathic scoliosis

STUDY DESIGN: A prospective clinical study comparing two instrumentation systems for the correction of idiopathic scoliosis. OBJECTIVES: To measure the short-term three-dimensional changes in the shape of the spine after corrective surgery and compare the Cotrel-Dubousset instrumentation to the more recent Colorado instrumentation to determine whether one system provides better three-dimensional correction. SUMMARY OF BACKGROUND DATA: Adequate three-dimensional correction of scoliotic deformities has been reported with the Cortrel-Dubousset instrumentation system. During the past decade, a new generation of more versatile and user-friendly spinal implants has appeared, but there are no reports available to indicate whether similar or better correction can be obtained with these newer systems. METHODS: The three-dimensional geometry of the thoracic and lumbar spine was documented in the standing position using a three-dimensional reconstruction technique based on multiplanar radiography in 67 adolescents with idiopathic scoliosis undergoing correction by a posterior approach. Changes in spinal shape were measured 3 days before and 1 month after the surgery in 31 patients with Cotrel-Dubousset instrumentation and 36 patients with Colorado instrumentation. RESULTS: In both groups, adequate three-dimensional correction of the scoliotic deformities was documented for thoracic and lumbar curves, with significant changes in the frontal plane, in the plane of maximum curvature, and in its orientation. When comparing both groups, better correction was obtained in the frontal plane with the Colorado instrumentation (65% vs. 48% with Cotrel-Dubousset), a finding that may be explained by the significantly greater proportion of pedicle screws used in this group. CONCLUSION: Both instrumentation techniques achieve an effective and comparable three-dimensional correction of the scoliotic deformities.