后路半椎体切除椎弓根螺钉内固定治疗先天性脊柱畸形

目的：评价后方入路半椎体切除并椎弓根螺钉矫形固定椎间植骨融合术治疗先天性脊柱侧后突畸形的疗效。方法：2005年1月～2009年12月,我科收集17例先天性半椎体并脊柱侧突后突畸形患儿,男11例,女6例,平均年龄11.8岁。患儿接受后路半椎体切除＋椎弓根螺钉矫形固定＋椎间隙半椎体之骨颗粒植入融合术,手术固定2～8椎体,椎体手术后佩戴胸腰背支具6个月以上,测量并比较术前、术后1周及术后1年侧后突之Cobb角,从而评估手术效果。结果：本组患儿侧突主弯Cobb角术前平均64.2°,术后18.3°,矫正率为71.5%;后突主弯Cobb角术前平均57.1°,术后22.6°,矫正率为60.4%。术后无神经功能障碍或术区感染等并发症发生。术后3个月植骨达到骨性融合,而且代偿性辅弯减少,躯干平衡改善。结论：后方入路半椎体切除并椎弓根螺钉矫形固定椎间植骨融合术治疗先天性脊柱侧后突畸形可以达到满意的治疗效果,其中,短节段固定又可以保留较多的椎体生长和运动功能。

Posterior hemivertebra resection combined with transpedicniar instrumentation for the surgical treatment of congenital spinal deformity

Objective：To evaluate clinical effect of hemivertebra resection only though posterior approaches and transpedicular instrumentation for the surgical treatment of congenital spinal deformity.Methods：From January 2005 to December 2009,17 patients included 11 males and 6 females with an average of 11.8 years,which underwent a single hemivertera resection through posterior approach and transpedicular fixation for correction of malformation.The resected hemivertera were made into bone granule and implanted into intervertebral space.The fixed segments were from two to eight.Holo-vest was applied in each patient for 6 months postoperatively.According to anterior-posterior and lateral plain films of the preoperational,postoperatively 1 week and 12 months,the angles of main curve of scolosis and kyphosis were measured so as to the clinical outcomes.Results：The average Cobb angle of scolosis in coronal plane in all cases changed from 64.2° preoperatively to 18.3° postoperatively with correction rate of 71.5%.The average Cobb angle of kyphosis in sagittal plane changed from 57.1° preoperatively to 22.6° postoperatively with correction rate of 60.4%.All cases showed satisfied outcomes and solid bone fusion postoperatively.No neurological complication or infection.The body implance and compensatory curves obviously improved.Conclusion：Himevertera resection and transpedicular instrumentation could be performed successfully only through posterior approach,meanwhile,the short-segment instrumentation has better effect of correction of the congenital kyphoscolosis and more growth and functional potential.