Ponté截骨联合椎间隙颗粒骨打压植骨治疗陈旧性胸腰椎骨折后凸畸形

 目的 探讨Ponté截骨联合椎间隙颗粒骨打压植骨矫正陈旧性胸腰椎骨折后凸畸形的有效性与安全性。方法 2010年6月至2013年3月,手术治疗陈旧性胸腰椎骨折后凸畸形13例,男7例,女6例;年龄32~78岁,平均54.5岁;伤椎为T₁₁ 1例、T₁₂ 4例、L₁ 5例、L₂ 3例。均存在进行性加重的腰背部疼痛、后凸畸形及不等程度的神经功能障碍。采用Ponté截骨,椎间隙松解并完整保留前纵韧带及尽量保留骨性终板,椎间隙内颗粒骨打压植骨实现初步矫形,再利用矫形棒进行二次矫形矫正后凸畸形。采用后凸Cobb角变化、植骨融合情况、视觉模拟评分(visual analog scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)、ASIA神经功能分级评价疗效。结果 均获得9~36个月的随访,平均(20.0±9.1)个月。随访12个月时均获得骨性融合。脊柱局部后凸角由术前平均42.2°(26°~54°)改善为术后平均7.1°(-7°~13°),平均矫正率为83.2%。骶骨后上角至脊柱矢状轴线的距离由术前平均2.91 cm(-3.0~7.8 cm)减小至术后1.35 cm(-0.5~3.8 cm),胸椎后凸角、腰椎前凸角、骶骨水平角均有不等程度地改善。VAS评分由术前平均(6.38±0.87)分降低至末次随访时平均(2.23±0.83)分,ODI评分由术前平均(55.0±12.1)分降低至末次随访时平均(20.6±7.3)分,差异均有统计学意义。ASIA分级术前C级6例(术后D级2例、E级4例)、D级7例均为E级。 结论 应用Ponté截骨联合椎间隙颗粒骨打压植骨治疗陈旧性胸腰椎骨折后凸畸形具有矫正角度大、融合率高、手术创伤小、并发症少等优势。     

应用生长棒技术治疗小儿先天性脊柱侧凸对椎体生长发育的影响

目的:观察应用生长棒技术治疗先天性脊柱侧凸的疗效,探讨生长棒撑开手术对撑开节段内外脊柱和椎体生长发育的影响。方法:2008年6月~2013年12月采用生长棒技术治疗先天性脊柱侧凸患儿221例,术后至少有两次脊柱CT检查且2次检查间至少有1次撑开的患儿31例,男17例,女14例,首次手术时年龄3.2~9.1岁;第一次CT检查时年龄为7.1±2.3岁;末次CT检查时年龄为10.0±2.1岁。1.0~5.9年内共进92次撑开手术,人均撑开次数为3次,年均撑开次数为1.1次。第一次CT检查平均为第2次撑开,末次CT检查平均为第5次撑开。测量并比较第一次和末次CT检查时患者生长棒撑开节段内外椎体高度、主弯Cobb角、矢状位胸后凸Cobb角、T1~T12和T1~S1高度、脊柱偏移距离。结果:第一次和末次CT检查时撑开节段内单个椎体高度为18.2±4.7mm和21.8±5.5mm,撑开节段外单个椎体高度为19.2±3.2mm和22.7±3.4mm,前后两次撑开节段内外椎体高度有统计学差异(P=0.035)。撑开节段内、外单个椎体高度增加为1.4±0.9mm/yr、1.2±0.9mm/yr,差异有统计学意义(P0.05),撑开节段内椎体比撑开节段外椎体生长快。两次测量时冠状位主弯Cobb角分别为56.8°±15.3°和52.9°±15.4°,矢状位胸后凸Cobb角为36.6°±18.9°和43.7°±18.2°,T1~12高度为16.7±3.3cm和19.1±3.3cm,T1~S1高度为27.9±4.7cm和32.5±4.7cm,差异均有统计学意义(P0.05);脊柱平移为18.6±15.2mm和20.0±21.4mm,差异无统计学意义(P0.05)。结论:应用生长棒技术治疗小儿先天性脊柱侧凸时撑开节段内的正常椎体生长速率快于撑开节段外的椎体生长速率,撑开期间胸椎和脊柱高度均相应增加。     

胸腰段或腰段特发性脊柱侧凸选择性后路融合术后未融合节段在冠状面平衡重建中的作用

 目的 探讨胸腰段或腰段特发性脊柱侧凸选择性腰弯融合术后冠状面躯干偏移的重建与未融合节段的关系。方法 回顾性分析2005年10月至2011年10月行后路选择性融合术并有至少2年完整随访资料的胸腰段或腰段特发性脊柱侧凸患者的影像学资料。测量患者术前、术后及末次随访时的全脊柱正、侧位X线片。观察术后至末次随访期间患者冠状面躯干偏移的变化,并对其与上胸弯、主胸弯、腰弯、远端未融合节段和骶骨倾斜角变化的关系进行多元线性回归分析。结果 共37例患者纳入回顾性分析,男4例,女33例;年龄12～20岁,平均（14.6±2.0）岁;随访时间为2～8.9年,平均3.6年。术前患者腰弯Cobb角平均为44.2°,末次随访时为10.3°,最终矫形率为75.7%;术前主胸弯Cobb角平均为25.2°,末次随访时为13.6°,最终矫形率为44.9%;术前躯干偏移平均为2.2 cm,术后矫正为2.0 cm,术前与术后比较无明显差异,末次随访时躯干偏移自发代偿至0.9 cm,术后与末次随访时比较差异有统计学意义。回归分析发现术后患者躯干偏移的变化仅与远端未融合节段角度的改变呈线性相关,回归方程：躯干偏移变化量（cm）=1.248 7+0.137 8×远端未融合节段Cobb角变化值（°）。结论 胸腰段或腰段特发性脊柱侧凸选择性后路腰弯矫形术后,冠状面躯干平衡的重建主要由远端未融合节段来代偿;尽管手术保留了大部分胸椎节段,但其在躯干偏移的代偿中并未发挥主要作用。     

先天性脊柱畸形手术治疗的总体疗效与并发症

目的:评估先天性脊柱畸形手术治疗的总体效果和并发症。方法 :回顾性分析2007年4月～2018年1月本团队手术治疗的431例先天性脊柱侧凸患者,其中男158例,女273例,平均年龄14.9±6.2岁。术前均行全脊柱CT平扫和全脊柱MRI,排查椎管内畸形情况;心脏彩超和腹部B超检查排除其他内脏畸形。手术方式包括:生长撑开型非融合矫形技术(包括生长棒和人工钛肋)治疗40例,后路半椎体切除短节段固定融合术48例,后路长节段矫形固定融合术(可含1、2级截骨)89例,后路截骨(3级及以上截骨)矫形长节段固定融合术254例。每位患者均于术后3个月、6个月、1年和2年及以上时间进行随访。术前、术后及随访时均拍摄站立位全脊柱正侧位X线片,测量脊柱侧凸Cobb角、矢状面平衡(sagittal vertical axis,SVA)及冠状面平衡(C7PLCSVL)。统计手术时间、术中出血量和手术并发症情况。结果:431例患者合并椎管内畸形351例次、合并其他内脏畸形24例次。平均手术时间为412.4±150.6min,平均术中出血量为1879.9±1727.6ml,平均随访时间48.7±9.3个月。脊柱侧凸术前平均Cobb角为68.88°±27.55°,术后平均Cobb角为28.86°±18.90°,末次随访时30.77°±19.80°;SVA术前平均为22.15±19.37mm,术后24.15±22.22mm,末次随访时19.75±16.06mm;C7PL-CSVL术前平均为17.37±15.47mm,术后21.95±47.29mm,末次随访时13.03±12.39mm,末次随访的脊柱侧凸Cobb角和C7PL-CSVL与术前比较均有统计学差异(P0.05)。术后肺部并发症49例、神经并发症30例、内固定相关并发症20例、术后感染10例以及脑脊液漏8例。结论:先天性脊柱侧凸手术矫形效果良好,但手术相关并发症风险较高,术后并发症总体发生率为30.16%,其中肺部并发症和神经并发症最为常见。     

一期后路截骨矫形术治疗重度脊柱畸形术后的并发症分析及处理

 目的 探讨一期后路截骨矫形术治疗重度脊柱畸形术后并发症原因及处理。方法 回顾性分析2006年9 月至2013年5月,采用一期后路截骨矫形内固定术治疗147例重度脊柱畸形患者资料,其中17例术后发生病发症,男5例,女12例;年龄14～51岁,平均22.6岁;先天性脊柱侧凸11例,先天性脊柱后凸4例,先天性脊柱侧后凸2例;术前主弯 侧凸Cobb角85°~160°,平均109°;后凸Cobb角65°~152°,平均104°。术前2例患者有神经症状,美国脊髓损伤协会ASIA分级均为D级。手术均采用椎弓根钉棒系统矫形固定,其中采用Smith?Petersen 截骨术2例、经椎弓根截骨术11例、全脊 椎截骨术4例。结果 17例出现并发症,并发症发生率为11.6%(17/147)。其中椎弓根螺钉置入椎管2例、截骨端合拢压 迫及牵拉神经2例、截骨处残留骨块压迫神经1例、急性脊髓损伤2例、感染2例、断棒及脱帽3例、肠系膜上动脉综合征5 例。术后7例发生神经系统并发症,其中2例由术前ASIA分级D级变为C级,5例由神经功能正常变为C级2例、D级3 例。采用再次手术调整钉棒、应用甲基泼尼松龙、神经营养药物、取出内固定、抗感染、翻修换棒及对症处理,15例完全恢复,2例好转。结论 严重脊柱畸形一期后路截骨矫形术后会出现神经系统及断棒、脱帽、肠系膜上动脉综合征等并发症。为避免发生并发症,术中应提高椎弓根钉置入的准确性,合理安置螺钉数量及位置,截骨端牵拉加压应适度,并彻底 咬除截骨端骨块,术后密切观察肢体感觉及运动变化情况,及时手术探查并解除神经致压因素,同时给予激素冲击、神经营养等药物,术后早期需佩戴合适支具,避免暴力撞击手术部位。     

蛋壳技术联合多椎板切除治疗成人先天性脊柱畸形

目的探讨蛋壳技术联合多椎板切除治疗成人先天性脊柱畸形的安全性及有效性。方法 13例先天性脊柱畸形患者均采用后正中切口,通过蛋壳技术去除椎体松质骨使原发弯顶椎变为空壳样,顶椎相邻节段椎板全切除,应用平移、去旋转结合凸侧加压、凹侧撑开钉棒系统内固定矫正,同时行自体骨混合同种异体骨脊柱后外侧植骨融合治疗。结果 13例共切除36个节段椎板;行蛋壳技术的椎体共16个;融合节段8～15个。手术用时230～430(305.4±62)min;术中出血量1 800～3 900 ml(2 646±651)ml。13例均获得随访,时间18～82(43.5±7.6)个月。末次随访时,脊柱主弯侧凸矫正率为49.2%,后凸矫正率为48.8%。未发现螺钉断裂、松动,无断棒现象。1例术后出现脑脊液漏,1例在末次随访时主诉有轻度腰背痛,1例随访71个月时出现相邻融合节段腰椎弓峡部裂。结论蛋壳技术联合多椎板切除钉棒系统内固定治疗成人先天性脊柱畸形是一种较安全有效的治疗方法。     

围截骨区卫星棒技术在严重脊柱畸形三柱截骨术中的应用

 目的 探讨严重脊柱畸形三柱截骨术中围截骨区卫星棒技术的可行性,并评估其临床应用价值。方法 回顾性分析2012年7月至2014年1月期间应用卫星棒技术行严重脊柱畸形三柱截骨并有完整临床及影像学资料的13例患者,男6例,女7例;年龄12~57岁,平均（30.9±19.1）岁。分别测量患者手术前后及末次随访时侧凸Cobb角、最大后凸Cobb角（global kyphosis,GK）、冠状面平衡（distance between C₇ plumb line and center sacral vertical line,C₇PL-CSVL）和矢状面平衡（sagittal vertical axis,SVA）。患者初诊及每次随访均填写SF-36量表。结果 随访时间平均为（15.8±3.8）个月。术前侧凸Cobb角平均为86.3°±22.6°,术后为45.2°±19.7°,较术前明显改善,平均矫正率为47.7%±19.1%;末次随访为39.9°±19.8°,随访期间未见明显矫正丢失。术前GK为80.9°±18.7°,术后为35.1°±14.5°,平均矫正率为57.8%±13.8%;末次随访时未见明显丢失,平均为36.3°±10.0°。手术前后C₇PL-CSVL分别为（43.7±36.8） mm、（18.8±5.6） mm,术后有明显改善;末次随访时维持良好,平均为（19.2±8.3） mm。SVA由术前平均（55.0±51.5） mm减小至术后（29.3±19.5） mm,末次随访为（34.2±17.5） mm,亦无明显矫正丢失。13例患者术中监测均无信号异常。术后1例患者1枚螺钉位置偏上穿出上终板,1例患者1枚螺钉位置偏外。患者随访期间均无明显矫形丢失及断钉、断棒等内固定并发症。结论 严重脊柱畸形三柱截骨引入卫星棒技术既满足坚强固定需要又起到分散应力作用,术后矫形效果满意,随访期间矫正丢失及内固定失败等并发症少。     

生长棒治疗伴椎管内异常的早发性脊柱侧凸的疗效及安全性分析

目的 :探讨生长棒治疗伴椎管内异常的早发性脊柱侧凸(early-onset scoliosis,EOS)的疗效及安全性。方法:2009年11月～2016年8月共73例EOS患儿于我院行生长棒治疗,其中伴椎管内异常的患儿中符合纳入标准的共11例,男2例,女9例,初次就诊年龄为8.2±1.3岁(6～10岁)。先天性脊柱侧凸9例,神经肌源性脊柱侧凸2例。伴单纯脊髓空洞3例,单纯脊髓拴系1例,单纯脊髓纵裂3例,脊髓空洞合并脊髓拴系2例,脊髓拴系合并脊髓纵裂1例,脊髓纵裂合并脊髓空洞、脊髓拴系1例。术前2例患儿存在神经系统症状,包括Honor综合征1例和神经源性膀胱伴会阴部麻木1例,其余患儿无神经系统损害表现。记录生长棒置入手术前后和末次随访时患儿站立位主弯Cobb角和T1-S1高度,采用配对t检验比较术前、术后及末次随访时的差异。记录术中及随访期间的神经及内固定并发症。结果:11例患儿共进行45次手术治疗,其中包括生长棒置入11次、生长棒撑开34次。平均撑棒间隔时间为11.2±1.1个月(8～12个月),总随访时长为39.7±11.6个月(24～72个月)。11例患儿生长棒置入术前主弯Cobb角为85.2°±23.4°,生长棒置入术后为51.4°±18.9°,末次随访时为52.8°±19.4°;生长棒置入术前站立位T1-S1高度为24.6±3.9cm,初次术后和末次随访时分别为28.9±3.4cm和31.9±3.4cm。初次术后和末次随访时主弯Cobb角和T1-S1高度与初次术前比较均有统计学差异(P0.001)。11例患儿中,共3例患儿出现5次并发症。1例患者在第3次撑开时发现冠状面失衡伴骨盆倾斜和钉棒松动,撑开同时行翻修术;1例第3次撑开后随访中发现下端椎螺钉松动合并矢状面失衡,10个月后行终末期融合手术;1例第2次撑开后发现近端交界性后凸,随访中无明显进展。所有患儿在生长棒置入和后续多次撑开及随访过程中均未观察到新发神经并发症。结论:对于伴有椎管内异常的EOS患儿,若无明显神经损害或神经损害相对稳定,行生长棒置入及多次撑开是相对安全有效的。     

双生长棒技术治疗早发性脊柱侧凸的中期疗效

目的:评估双生长棒技术治疗5岁以下早发性脊柱侧凸患儿的中期疗效,分析相关并发症原因。方法:回顾性研究2004年2月~2012年6月于我科接受双生长棒技术治疗的14例(男4例,女10例)早发性脊柱侧凸患儿;平均年龄3.5±1.2岁(2~5岁)。通过复习病历,对年龄、撑开次数以及并发症进行记录;同时对影像学资料进行测量分析。测量指标包括侧凸Cobb角、胸后凸、腰前凸、T1-S1距离以及内固定的长度,对畸形的矫正情况以及脊柱、胸廓的生长指标——坎贝尔的空间供肺比值(Campbell′s space available for lung ratio,SAL)进行评估。结果:所有患儿平均随访时间为54.6±22.4个月(24~100个月)。14例患儿共接受99次手术,其中85次为撑开术,平均每例患者经历6.1次撑开术。冠状面主弯Cobb角术前73.8°±19.1°,术后35.8°±12.8°,末次随访时34.5°±16.3°。T1-S1距离从术前23.9±4.2cm增至术后27.1±4.8cm,末次随访时为33.6±5.2cm,平均年增长率为1.61cm/y。内固定长度初次手术术后为23.1±5.3cm,末次随访时为28.0±6.2cm。SAL术前为0.90±0.10,术后改善至0.92±0.09,末次随访时为0.96±0.11。有4例患者发生8例次并发症,主要为内固定相关(7例次)并发症,均在撑开手术同时进行翻修;无感染以及神经系统并发症发生。结论:双生长棒技术用于治疗5岁以下、保守治疗无效的进展性早发性脊柱侧凸患儿,不仅可以有效地控制脊柱畸形的进展,保留脊柱的生长潜能,而且对患儿胸廓畸形也具有一定的矫正作用;尽管该技术内固定失败发生率较高,但通过翻修手术仍可以获得满意的临床疗效。     

后路单侧经椎弓根半椎体截骨治疗青少年先天性脊柱侧凸

目的评估后路经椎弓根截骨矫形部分半椎体保留治疗先天性半椎体所致脊柱侧凸畸形的临床疗效。方法共18例先天性半椎体合并脊柱侧凸患者纳入随访研究,平均年龄16.17岁（14～21岁）,术前测量半椎体所致脊柱畸形的节段性主弯Cobb角45.39°±6.81°,头侧代偿弯Cobb角27.5°±2.71°,尾侧代偿弯Cobb角为26.44°±6.85°,顶椎偏距为4.28±0.58cm,节段性后/前凸角度为14.11°±18.07°。所有病例均采用后路一期经半椎体椎弓根截骨,双侧固定矫正侧凸畸形。随访时间为14.17±6.56个月。综合评估影像学、临床疗效以及并发症的情况。结果手术时间为2.82±0.74h,术中失血量317.22±65.15ml。术后节段性主弯Cobb角为11.33°±4.68°,矫正34.06°±7.88°,末次随访14.61°±4.96°;头侧代偿弯Cobb角为8.72°±1.44°,矫正18.78°±3.17°,末次随访18.78°±3.17°;尾侧代偿弯Cobb角为7.98°±1.82°,矫正18.47°±5.83°,末次随访18.47°±5.83°;节段性后/前凸角为-1.94°±12.35°,矫正14.94°±10.18°,末次随访-1.5°±12.67°。顶椎偏距的矫正为2.31±0.52cm,末次随访2.1±0.24cm。术中没有血管、神经损伤、骨折等重大并发症发生,术后没有发生冠状面和矢状面的失代偿。结论后路半椎体经椎弓根截骨矫形能有效矫正轻、中度先天性半椎体所致脊柱侧凸畸形,缩短手术时间,创伤小,减少术中失血量,矫形效果满意,所选病例骨骼发育相对成熟者,避免矫形丢失。     

生长阀双棒内固定技术治疗儿童严重脊柱侧凸的初步临床应用

目的 评价生长阀双棒内固定技术治疗早发的儿童脊柱侧凸的初步应用结果 .方法 2004年11月至2009年3月行生长阀双棒内固定技术治疗儿童脊柱侧凸11例,男1例,女10例;年龄2.1～10.9岁,平均6.1岁.Risser征均为0级.胸椎侧凸8例,胸腰椎侧凸3例;先天性脊柱侧凸10例,神经肌肉性脊柱侧凸1例.10例采用Isola生长阀固定,1例采用TSRH生长阀固定.撑开1～4次,平均1.8次.随访4.2～38.1个月,平均17.3个月.结果 术前主弯Cobb角67.64°±11.43°,胸后凸31.00°±22.40°,躯干偏移(2.00±1.73)cm,T1S1高度(25.47±6.16)cm;初次术后主弯Cobb角34.64°±8.26°,胸后凸23.00°±8.06°,躯干偏移(1.49±1.31)cm,T_1～S_1高度(28.84±5.69)cm;末次术后主弯Cobb角36.82°±11.76°,胸后凸27.18°±8.97°,躯干偏移(1.11±1.29)cm,T_1～S_1高度(31.29±4.50)cm.术前、初次术后和末次术后主弯侧凸角比较差异有统计学意义.初次手术矫止率47.15%±16.48%,T_1～S_1高度增加(3.37±1.62)cm;末次手术矫正率44.73%±19.43%,T_1～S_1高度增加(5.82±2.21)cm.治疗期间T_1～S_1每年平均生长1.6 cm(1.1～2.7 cm).5例出现并发症:3例脱钩,1例椎弓根螺钉脱出,1例断棒.结论 生长阀双棒内固定技术允许脊柱纵向生长,同时起到矫形和控制畸形发展的作用,但术后并发症发生率较高.     

Thoracic kyphoscoliosis resembling neurofibromatosis: a case report focusing on subfascial instrumentation.

BACKGROUND CONTEXT: The management of early-onset progressive scoliosis is controversial. PURPOSE: To describe the unusual surgical management of a young female with an early-onset progressive, short, angular kyphoscoliosis resembling neurofibromatosis. STUDY DESIGN: A case report reviewing the treatment of an unusual occurrence of kyphoscoliosis. METHODS: After compliant Milwaukee brace wear had failed to stop deformity progression, surgical management including segmental anterior and posterior T5-T10 arthrodesis, and posterior T3-L4 subfascial rod instrumentation was performed at age 4 years and 6 months. After 10 rod lengthenings, segmental anterior T10 to L3 arthrodesis and posterior T3-L4 instrumentation and arthrodesis were done at age 11 years and 5 months. RESULTS: From preoperative to 3-year postoperative definitive surgery, her T3 to L4 instrumented spine length increased by 9.5 cm; 4 cm after the initial surgery, 3 cm between the initial surgery and the definitive surgery and 2.5 cm after the definitive surgery. From preoperative to latest follow-up, her thoracic scoliosis was reduced from 89 to 31 degrees, her thoracolumbar compensatory scoliosis from 59 to 37 degrees and her kyphosis from 70 to 17 degrees. CONCLUSIONS: The combination of early definitive anterior and posterior major curve arthrodesis with a subfascial rod lengthening program to control the remainder of the thoracolumbar spine was a satisfactory solution for this unusual case of early-onset, progressive, short, angular kyphoscoliosis.     

脊柱侧凸手术治疗进展

对治疗脊柱侧凸的最新的手术技术进行综述,包括前后路脊柱融合技术、胸腔镜治疗脊柱侧凸技术,以及针对具有生长潜能的儿童性脊柱侧凸的非融合手术技术,包括:生长棒技术,VEPTR技术、椎体U形钉侧凸矫形技术,还有目前多用于僵硬性严重脊柱侧凸的多椎体楔形截骨术.通过回顾复习各种治疗脊柱侧凸手术治疗技术,继承发展适合不同类型脊柱侧凸类型的手术技术,提高脊柱侧凸手术疗效及患者术后生存质量.     

选择性短节段固定融合治疗退行性脊柱侧弯

目的 探讨采用选择性短节段固定融合的方法治疗退行性脊柱侧弯的临床疗效及体会。方法本组回顾性研究18例采用短节段固定融合的方法治疗退变性脊柱侧弯患者,对术前、术后及随访时患者的影像学、临床疗效功能评分进行记录和评估,分析采用该术式手术治疗的有效性。结果所有患者均顺利完成手术,和术前相比,患者的脊柱侧弯Cobb角有所改善,而腰腿痛VAS指数、ODI功能指数均得到有效的改善和随访时的维持。结论 采用选择性短节段固定融合治疗退行性脊柱侧弯可以有效减压脊柱疾病的责任节段的压迫、损伤小,获得较好的临床疗效,但长期的随访需要进一步的分析。     

Submuscular Isola rod with or without limited apical fusion in the management of severe spinal deformities in young children: preliminary report

STUDY DESIGN: Retrospective review of the results of submuscular rod placement with and without limited apical fusion for the treatment of severe spinal deformities in young children. OBJECTIVES: To determine the success of this method for controlling severe deformities while allowing for spinal growth and to compare this method with previously reported results. SUMMARY OF BACKGROUND DATA: A variety of methods for controlling scoliosis in young children have been reported, but complications including spontaneous fusion, loss of correction, instrumentation failure, and limited spinal growth are common. METHODS: The cases of 29 young children with progressive scoliosis or kyphoscoliosis as a result of a variety of diagnoses treated with a submuscular Isola rod and a postoperative orthosis were retrospectively reviewed. Eleven patients also had a short anterior and posterior apical fusion or convex hemiepiphysiodesis to aid in correction and stabilization of their deformity. The remaining 18 patients had a submuscular rod only. RESULTS: The mean age at surgery was 6.7 years (range, 1-11 years). The initial preoperative mean magnitude of the major curve was 66 degrees (range, 42-112 degrees ). After surgery this decreased to a mean of 38 degrees (range, 16-70 degrees ). The most recent radiographs demonstrated a mean 47 degrees curve (range, 28-79 degrees ). The mean number of lengthenings per patient has been two (range, 0-5). Nine patients have reached a suitable age and have been converted to a posterior spinal fusion and segmental spinal instrumentation. Nine complications have occurred in seven patients (24%). These included five hook displacements and three rod breakages. These were treated by hook reinsertion and rod exchange or sleeve and a repeat lengthening. There was one superficial infection treated medically. CONCLUSION: This technique is useful in the management of severe spinal deformities in young children who have either failed, or have a contraindication to, orthotic management. Complications are relatively frequent but well tolerated.     

生长棒技术治疗早发性脊柱侧凸术后的肺功能变化

 目的 分析生长棒技术治疗早发性脊柱侧凸术后的肺功能变化。方法 2002年9月至2011年7月,以生长棒技术治疗早发性脊柱侧凸患者10例,男3例,女7例;年龄6~9岁,平均(7.0±1.1)岁。9例为先天性脊柱侧凸,1例为神经肌肉型脊柱侧凸。4例已完成最终融合手术(已融合组),6例未完成最终融合手术(未融合组)。记录每次手术术前的用力肺活量(FVC)、一秒钟用力呼气容积(FEV1)、Cobb角、C7-S1距离,计算FVC、FVC/FVC预测值百分比、FEV1、FEV1/FEV1预测值百分比变化,分析FVC变化与Cobb角变化及C7-S1距离变化的相关性。结果 已融合组中FVC与FEV1均增高,其中最终融合术前与生长棒置入术前FVC的差异有统计学意义。未融合组中FVC与FEV1均增高,末次延长术前与生长棒置入术前FVC、FEV1的差异均具有统计学意义。两组病例生长棒置入术前与末次手术前FVC/FVC预测值百分比及FEV1/FEV1预测值百分比的变化均无统计学意义。FVC变化与Cobb角变化及C7-S1距离变化值无相关性。结论 生长棒技术治疗早发性脊柱侧凸术后肺功能得到改善,肺功能的改善与Cobb角变化及C7-S1距离变化无关。     

Short anterior instrumented fusion and posterior convex non-instrumented fusion of hemivertebra for congenital scoliosis in very young children

A variety of treatments has been described in the literature for the treatment of HV. We report the results of early surgical anterior instrumented fusion with partial preservation of the HV and posterior non-instrumented fusion in the treatment of progressive congenital scoliosis in children below the age of six. Between 1996 and 2006, 31 consecutive patients with 33 lateral HV and progressive scoliosis underwent short segment fusions. Mean age at surgery was 2 years and 10 months. Mean follow-up period was 6.1 years. The major scoliotic curve improved from 41° preoperatively to 17° on follow-up. Preoperative segmental Cobb angle averaging 39° was corrected to 15° after surgery, being 15° at the last follow-up (62% of improvement). Compensatory cranial and caudal curves corrected by 47 and 45%, respectively. The angle of segmental kyphosis averaged 16° before surgery, 11° after surgery, and 11° at follow-up. There were two wound infections requiring surgical debridment, one intraoperative fracture of the vertebral body and one case lost correction due to implant failure. All went on to stable bony union. There were no neurological complications. Early diagnosis and early and aggressive surgical treatment are mandatory for a successful treatment of congenital scoliosis and prevention of the development of secondary compensatory deformities. Anterior instrumentation is a safe and effective technique capable of transmitting a high amount of convex compression allowing short segment fusion, which is of great importance in the growing spine. Study conducted at the Great Ormond Street Hospital for Children and the Royal National Orthopaedic Hospital, Stanmore, London, UK.     

Hemivertebra resection and scoliosis correction by a unilateral posterior approach using single rod and pedicle screw instrumentation in children under 5 years of age

Ten consecutive patients under 5 years of age with congenital scoliosis caused by single-level hemivertebra underwent hemivertebra resection and scoliosis correction by a unilateral posterior approach using single rod and pedicle screw instrumentation. The mean age at the time of surgery was 3.3 years. The mean correction of main curve, segmental curve, and segmental kyphotic angle was 65.9, 62.8, and 78.1%, respectively. The average follow-up duration was 3.5 years. All patients achieved solid fusion on the convex side. No patient required revision surgery. The results indicate that this therapeutic method is less traumatic, simple, and safe.     

早发性脊柱侧弯行传统生长棒治疗并最终融合后再次手术的危险因素

目的探讨早发性脊柱侧弯(early onset scoliosis,EOS)接受传统生长棒手术并最终融合后再次手术的危险因素。方法选择2011年1月~2018年6月在本院接受传统生长棒治疗并最终行融合术的143例EOS患儿作为研究对象,收集首次传统生长棒术前、围手术期、延长手术过程中、最终融合手术期间等临床资料,根据融合术后是否行翻修手术,将患儿分为翻修组和未翻修组,观察两组患儿的临床资料差异,采用多因素分析确定影响EOS最终融合术后面临翻修的风险因素。结果最终融合术后翻修手术发生率为18.18%。翻修组和未翻修组患者首次传统生长棒手术期间的生长棒深度、跨越节段、冠状面T₁-S₁长度有统计学差异(P<0.05);两组延长时间、感染、锚点相关并发症、交界性后凸、侧凸进展、非计划手术等因素比较,差异有统计学意义(P<0.05);两组患儿最终融合术时的万古霉素粉应用、主弯Cobb角等资料比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,生长棒跨越的节段数量、生长棒治疗时间、生长棒延长时的侧凸进展,均是翻修手术的风险因素(P<0.05)。结论EOS最终融合术后具有较高的翻修率,受多项因素影响,需引起临床重视。     

The treatment of scoliosis in cerebral palsy by posterior spinal fusion with Luque-rod segmental instrumentation

Thirty-three patients who had cerebral palsy and scoliosis underwent posterior spinal fusion with Luque-rod segmental instrumentation. The mean curve measured 65 degrees preoperatively and 30 degrees postoperatively. The mean loss of correction was 3 degrees after a mean length of follow-up of forty months. As of the time of writing, pseudarthrosis had not developed in any patient. No patient had a broken rod or an increased neurological deficit. There were no major pulmonary complications. The most common early postoperative complication was wound infection, which occurred in five patients, none of whom required removal of the hardware. We concluded that posterior spinal fusion with Luque-rod segmental instrumentation is an effective method of obtaining and maintaining correction of a spinal curve, with minimum complications, in patients who have cerebral palsy and progressive scoliosis.