后路半脊椎切除短节段内固定治疗小儿半脊椎脊柱畸形

[目的]探讨一期后路半脊椎切除、短节段内固定治疗半脊椎所致小儿先天性脊柱侧后凸畸形的临床疗效。[方法]回顾性分析2004年1月~2010年1月本院35例采用一期后路半脊椎切除、短节段内固定术治疗的半脊椎所致先天性脊柱侧后凸患儿,手术年龄4岁1个月~8岁5个月,平均6岁3个月。通过术前、术后及随访时站立位脊柱正位和侧位X线片测量,评价冠状面及矢状面的矫形效果。[结果]术后均随访5年以上,平均7年10个月。节段侧凸角术前平均33.20°,术后2周平均6.70°,矫正率79.82%,总侧凸角术前平均37.5°,术后2周9.9°,矫正率为73.60%;后凸角术前平均21.3°,术后2周7.9°,矫正率为62.91%。术中和术后发生螺钉切割椎弓根3例,术后切口局部感染1例。无神经系统并发症发生。末次随访侧凸及后凸矫形角度均无明显丢失。[结论]采用一期后路半脊椎切除、短节段内固定术治疗半脊椎所致的小儿先天性脊柱侧后凸融合节段少,不影响其他正常脊柱节段的生长发育,矫形效果良好,固定牢靠,并发症少,临床疗效满意,是一种安全和可行的方法。     

后路半椎体切除矫治半椎体所致脊柱侧后凸畸形

[目的]评价后路半椎体切除术治疗半椎体所致脊柱侧后凸畸形的临床效果。[方法]2000年5月~2005年11月,采用后路半椎体切除及矫形固定融合术治疗14例完全分节半椎体所致脊柱侧后凸畸形患者。年龄2.5~14.4岁,平均7.4岁,半椎体均为侧后方半椎体,其中胸椎7例,腰椎7例。[结果]手术时间2~7 h,平均4.7h,术中出血量150~2 500 m l,平均560 m。l固定节段2~8个椎体,平均3.5。术后随访6~36个月。平均15.6个月。术后站立位脊柱正侧位X线片示冠状面Cobb's角由术前46.2°矫正到17.3°,平均矫正率62.6%,矢状面Cobb's角由术前48.3°矫正至术后16.2°,平均矫正率68.7%。终末随访时冠状面Cobb's角平均21.7°,丢失4.4°,矢状面Cobb's角平均18.7°,丢失2.5°。围手术期并发症包括:伤口愈合不良2例,术中术后椎弓根螺钉切割椎体2例。[结论]后路半椎体切除可直接去除致畸因素,在冠状面及矢状面均获得良好的矫形效果,与前后路手术相比可缩短手术时间,减少创伤,适用于从胸段到腰段的半椎体畸形。     

后路半椎体切除内固定矫治先天性脊柱侧后凸

目的评价后路一期半椎体切除椎弓根钉矫形治疗先天性半椎体所致脊柱侧后凸的临床效果。方法11例患者,平均年龄9.3岁,4例位于胸椎,5例位于腰椎,均为完全分节型,手术采用后路一期半椎体切除,椎弓根器械矫形并植骨融合。结果手术固定节段2-7个椎体,平均3.3个椎体。术后随访6-30个月,平均14.5个月。全脊柱正侧位X线片示冠状面Cobb角由术前平均41.15°矫正至15.35°,平均矫正率61.53％,矢状面Cobb角由术前平均34.15°矫正至13.26°,平均矫正率60.27％,顶椎偏移由术前25.34mm矫正至11.46mm,最后随访时侧凸和后凸Cobb角平均分别为16.86°和14.08°,与术后相比无纠正丢失。无任何手术并发症,无内固定断裂脱落,均融合。结论一期后路半椎体切除椎弓根器械矫形是治疗先天性脊柱侧后凸安全、有效的术式,能够获得满意的矫正。     

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。     

半椎体切除术治疗先天性脊柱侧后弯畸形

目的分析一期后路半椎体切除治疗先天性脊柱侧后凸畸形的手术效果,并探讨手术固定融合节段方案的选择。方法回顾分析15例由半椎体引起侧后凸畸形的患儿,其中男9例,女6例,年龄3～17岁,平均13.5岁。均行后路半椎体切除、矫形内固定及情骨融合手术。结果随访15～68个月,平均40.5个月。术后矫形效果满意,侧凸畸形由术前平均45.3°改善至11.4°（矫正率达68.7%）;后凸畸形由术前的平均35.5°,矫正至11.4°（矫形率达67.9%）,远期矫形丢失率低,植骨融合良好,无内固定物断裂松动等并发症。结论一期后路半椎体切除、椎弓根钉棒系统矫形内固定和植骨融合手术,可以有效矫正青少年脊柱结构性侧后凸畸形。     

后路半椎体切除节段固定矫正侧后凸畸形疗效初步观察

目的 :观察和评价由单个先天性半椎体引起的侧后凸畸形经一期后路半椎体切除及节段矫形内固定的初期手术效果。对象与方法 :对 10例由单个先天性半椎体引起的侧后凸畸形患者进行回顾性分析。年龄在 8～ 14岁之间 ,均经一期后路半椎体切除及节段性矫形内固定。随访 6个月～ 2年 (平均 1年 2个月 )。术前、术后及随访时摄站立位脊柱全长正侧位片进行观察。结果 :10例患者术前均有侧后凸畸形。术后侧凸角度由平均 69°改善至 2 8° (矫正率 60 %) ;后凸畸形由术前的平均 48°矫正至平均 19°。随访获初步或坚强融合 ,无神经系统损伤、感染及内固定失败等并发症发生。结论 :由先天性半椎体所引起的脊柱侧后凸畸形可经一期后路半椎体切除和节段矫形内固定而获得满意的矫形效果。手术适应证为由胸椎或胸腰段半椎体畸形所引起的青少年患者的结构性侧后凸畸形。     

前后路切除半椎体治疗先天性脊柱侧凸

目的　探讨前后路切除完全分节型半椎体治疗先天性脊柱侧凸的疗效。方法　采用一期前后路切除共 12个半椎体治疗 11例儿童先天性脊柱侧凸 ,所有半椎体均为完全分节型 ,T10 、T11、L1、L4各 1例 ,L2 、L3 各 2例 ,T12 4例 ,术前Cobb角 35°～ 95°,平均 4 9°。结果　随访 9～ 30个月 ,平均 2 0个月。术后冠状面平均矫正 5 3% ,平均矫正丢失 5°,2例后凸畸形术后得到纠正 ,无神经并发症和假关节发生。结论　一期前后路切除完全分节型半椎体治疗先天性脊柱侧凸能取得满意疗效。     

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。     

一期后路经椎弓根半椎体切除节段固定治疗先天性胸腰椎侧后凸畸形

目的：评价一期后路经椎弓根半椎体切除节段固定术治疗完全分节的胸腰椎半椎体畸形所致的先天性脊柱侧后凸畸形的疗效。方法：采用一期后路经椎弓根半椎体切除内固定矫形术治疗了12例完全分节的胸腰椎半椎体畸形所致的脊柱侧后凸畸形，其中，男8例，女4例，年龄7～17岁，平均11．3岁。观察并测量术前术后及随访时站立位脊柱X线片冠状面和矢状面Cobb角、侧凸的顶椎偏移。结果：随访10～34个月，平均16个月。术后冠状面平均矫正64．1％，随访中无明显丢失。后凸由术前平均32。矫正至19。，随访中无明显丢失，顶椎偏移由术前4．5cm矫正至1．2cm。无脊髓损伤及切口感染等并发症。结论：一期后路经椎弓根半椎体切除内固定矫形术是治疗完全分节的胸腰椎半椎体畸形所致的脊柱侧后凸畸形的有效方法。     

后路经椎弓根半椎体切除固定融合治疗完全分节型胸腰椎侧后凸畸形

目的:评价一期后路经椎弓根半椎体切除固定融合治疗完全分节型胸腰椎侧后凸畸形的疗效.方法:采用自制的"V"型截骨刀一期后路经椎弓根半椎体切除内周定矫形治疗52例完全分节型胸腰椎半椎体畸形所致的脊柱侧后凸畸形患者.应用术前、术后X线片冠状面节段侧凸角、总侧凸角和代偿侧凸角以及矢状面节段后凸角或前凸角、躯干侧移程度对治疗结果进行评估.结果:手术时间120～310min,术中失血量300～600ml.同定融合椎体节段数2～4个.所有病例随访2年7个月～5年.平均3年5个月.1例术中凸侧节段加压时头端椎弓根被螺钉割裂,向上延长一个椎体固定;2例术后出现神经根性分布的一侧肢体麻木、胀痛,3个月随访时症状消失;3例患者因术中行胸神经根切断,术后出现支配区域柬带感,术后2个月缓解.1例因内同定钉帽切迹导致皮肤溃烂,1年后复查已骨性融合,取出内同定后治愈.1例5个月复查时出现椎弓根被螺钉割裂,延长支具固定6个月,骨性融合后取出内固定.末次随访时节段侧凸角由术前38.5°±6.9°矫正至7.5°±3.0°总侧凸角由术前41.2°±8.1°矫正至9.6°±5.1°,头侧代偿凸由术前17.5°±5.2°矫正至6.20±4.1°尾侧代偿凸由术前17.9°±4.9°矫正至6.1°±3.1°,后凸角由术前29.1°±12.1°矫正至6.2°±4.1°,躯干偏移由术前平均4.5cm矫正至0.4cm.各指标末次随访时与术前比较P<0.01.结论:一期后路经椎弓根半椎体切除固定融合治疗完全分节型胸腰椎侧后凸畸形效果良好.     

Progression of congenital scoliosis due to hemivertebrae and hemivertebrae with bars.

From 315 cases of congenital scoliosis seen from 1925 to 1970, sixty cases of scoliosis or kyphoscoliosis due only to a hemivertebra, hemivertebrae, or a unilateral bar associated with the hemivertebrae were selected, classified into six types, and analyzed. Progression occurred in all but the balanced hemivertebrae group in two patients with cervical-high thoracic curves due to multiple hemivertebrae. Location of the hemivertebra or hemivertebrae and the presence of unilateral bars are the major determinants of deformity. The rate of progression of the scoliosis was variable, ranging from 1 to 33 degrees per year (average, 4 degrees per year).     

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.     

Comparison of one-stage anteroposterior and posterior-alone hemivertebrae resection combined with posterior correction for hemivertebrae deformity

Background:

The surgical technique of hemivertebrae excision varies from anteroposterior procedures to posterior-alone resections according to the experience and preference of surgeons. Both the approaches are reliable and give relatively good results. This study aims to evaluate and compare the clinical and radiological results of these two approaches for hemivertebrae resection.

Materials and Methods:

Sixty patients were retrospectively enrolled between 2006 and 2009. The subjects included 32 women and 28 men, with a mean age of 12.9 years (range: 5–24 years). Thirty patients who underwent one-stage anteroposterior hemivertebrae resection (the AP group) were followed for 38.5 months, and the other 30 patients who underwent posterior resection (the P group) were followed for 20.6 months. Clinical and radiological assessments were performed preoperatively, 1 week postoperatively, and at the final follow-up. The operation time, blood loss, degree of correction of the main curve/segmental curve/kyphosis, the average hospital stay, and complications were reviewed and compared between the two groups.

Results:

The mean operation time, blood loss, and hospital stay of the AP group and the P group were 451 min vs 248.5 min, 1290 ml vs 910 ml, and 21.93 days vs 18.97 days, respectively (P<.05). The average correction rate of the main curve/segmental curve/kyphosis of the AP group and the P group was 68.5% vs 66.2%, 71.5% vs 69.6%, and 57.4% vs 56.1%, respectively (P>.05). Overall complication rate was 6.7% in the AP group vs 10% in the P group (P>.05).

Conclusion:

Posterior hemivertebrael resection is a promising approach for congenital scoliosis in terms of relative safety, degree of correction achieved, reduced operative time and blood loss.     

Incomplete penoscrotal transposition associated with hemivertebrae

Penoscrotal transposition is a rare anomaly of external genitalia, often associated with a variety of defects usually related to the urinary and the gastrointestinal tracts and the vertebral column. We report such a patient with hemivertebrae at L4-5, who had no other urological anomaly. To our knowledge this anomaly as an isolated urological entity with hemivertebrae has not been reported before. A brief mention is made of the embryology, incidence and various surgical techniques of correction.     

胸椎半椎体畸形合并脊髓纵裂的手术治疗

目的:探讨胸椎先天性半椎体脊柱侧凸畸形合并脊髓纵裂的手术治疗方法.方法:2003年1月至2007年6月,共收治10例先天性半椎体脊柱侧凸畸形合并脊髓纵裂患者,男4例,女6例,年龄16～22岁,平均17.4岁.均为单个完全分节半椎体,病变位于T11 3例,T12 7例.采用一期后路半椎体及骨性分隔切除内固定矫形治疗,定期随访患者,评价术后矫正率.结果:10例患者均获得有效半椎体及骨性分隔切除,无神经损伤,术前侧凸Cobb角为40°～86°,平均53.6°;术后Cobb角为5°～28°,平均16.5°,侧凸矫正率平均69.3%.随访9～45个月,平均32个月,术后3～5个月截骨间隙达到骨性融合,无内固定失败及假关节形成.末次随访时有1.6°角度丢失.结论:应用一期后路半椎体及骨性分隔切除内固定矫形治疗先天性半椎体脊柱侧凸畸形伴脊髓纵裂效果满意,近期疗效可靠.     

腰骶部半椎体畸形的临床评估与手术治疗进展

半椎体畸形是指一侧椎体发育形成障碍而导致的椎体畸形,是造成先天性脊柱畸形的重要原因之一[1]。McMaster等[2]将半椎体分为完全分节、半分节和未分节三种类型。完全分节型的半椎体具有完整的上下生长板,单侧具有“正常”的生长潜能,脊柱畸形往往较严重且进展迅速[3]。除了半椎体的类型之外,半椎体的位置对先天性脊柱畸形的临床表现、严重程度和预后进展也有着重要影响[2]。腰骶部的半椎体,位于较为活动的腰椎和不活动的骶椎之间,由于半椎体下方缺少柔软的脊椎代偿,腰骶部半椎体畸形可产生一系列特殊的临床问题[4~7]。笔者就腰骶部半椎体畸形的临床评估与手术治疗的进展综述如下。     

小儿半椎体畸形的外科治疗探讨

目的：探讨小儿半椎体畸形的外科治疗及相关问题。方法：手术治疗94例半椎体畸形患儿，按照术式分为单纯半椎体切除组及半椎体切除后路加压固定组，随访观察术后情况，比较治疗效果。结果：两组侧弯均得到控制，后路加压固定组侧弯矫正明显好于单纯组，但术后并发症较多。结论：小儿半椎体畸形应早期手术治疗，前后路切除半椎体并加压固定可获得较好的治疗效果。