婴幼儿期背部烫伤致青少年瘢痕挛缩性脊柱侧弯

目的 探讨婴幼儿期背部烫伤所致青少年瘢痕挛缩性脊柱侧弯的发病机制、临床表现和治疗方法。方法 1997年8月～2003年6月共诊治各类儿童及青少年脊柱侧弯7000余例，其中仅有2例为瘢痕挛缩性脊柱侧弯，均伴有不同程度的骨盆倾斜。1例先行皮肤扩张、背部瘢痕切除、皮瓣转移术，再行脊柱侧弯前路TSRH矫形内固定术。另1例先行背部瘢痕切除、脊柱侧弯前路松解手术，Halo-股骨牵引50d后再行后路TSRH矫形内固定加胸廓成形术。结果 2例患儿术后外观畸形明显改善，侧弯矫正率分别为91．0％和55．0％，躯干变直，骨盆水平，伤口愈合良好。经3～4个月随访，无明显矫正丢失。结论 婴幼儿期烫伤所致背部严重瘢痕，可在青少年生长发育期诱发瘢痕挛缩性脊柱侧弯，其发病机制、临床表现均与典型青少年特发性脊柱侧弯有所不同。这一类型脊柱侧弯手术方案的制定必须遵循个体化、特异性的治疗原则。

Adolescent scar contracture scoliosis caused by back scalding during infantile period

Objective To investigate the pathogenesis, clinical presentation and treatment of the adolescent scar contracture scoliosis caused by back scalding during infantile period.Methods From Aug 1997 to June 2003, among about 7000 treated juvenile and adolescent scoliosis, there were two patients with adolescent scar contracture scoliosis. One patient was first treated with skin expansion, back scar excision and skin flap transfer followed by anterior scoliosis correction with TSRH instrumentation. Another patient was first treated with back scar excision and anterior spinal release. Posterior correction with TSRH instrumentation and thoracoplasty were performed after halo femoral traction for 50 days.Results The deformities of the two patients improved significantly after operation. The percentages of scoliosis correction were 91.0% and 55.0% respectively. Their trunks recovered erect and their pelvises became level. The wounds healed very well. With a follow up period of 3 4 months, there was no loss of the correction. Conclusions Severe scar contracture caused by back scalding during infantile period can lead to adolescent scoliosis. Its pathogenesis and clinical presentation are different from the typical adolescent idiopathic scoliosis. The treatment of this kind of scoliosis should be individualized with the specific basic principles.