小儿复杂性先天性脊柱侧凸二例分期手术的疗效分析

目的 探讨分期手术治疗小儿复杂性先天性脊柱侧凸的可行性及临床疗效。方法 回顾性分析2006年7月和2013年1月山西医科大学第二医院骨科手术治疗的2例小儿复杂性先天性脊柱侧凸患者的临床资料,其中男、女性各1例,年龄分别为6岁和9岁。均采用分阶段手术治疗,术后在脊柱X线正、侧位片上,通过观察患儿躯干冠状面和矢状面的平衡改善情况、冠状面Cobb角的改善情况、肩部平衡的改善情况等,来评定治疗效果。结果 患儿男一期手术后Cobb角从术前78°改善到术后40°,肩胛骨高度差缩小到6 cm;二期手术后Cobb角改善到16°,肩胛骨高度差缩小到5 cm,术后6年Cobb角改善到10°;三期肩胛骨下移术后双侧肩胛骨高度差缩小到2 cm;术后8年Cobb角改善到10°,双侧肩胛骨高度差缩小到1 cm。患儿女一期手术主胸弯Cobb角从术前53°改善到术后11°、腰弯Cobb角改善到21°,冠状面和矢状面均平衡,术后1年腰弯Cobb角增大到30°、冠状面出现失衡、C₇铅垂线(C₇PL)至骶骨中垂线(CSVL)距离为8 cm;二期术后半年腰弯Cobb角改善到3°、C₇PL至CSVL距离改善为4 cm,术后1年腰弯Cobb角进一步改善到1°、C₇PL至CSVL距离改善到3 cm。2例均无手术并发症发生。结论 分期手术治疗复杂性小儿先天性脊柱侧凸可操作性强、风险小、临床疗效好。

Staging surgery in treatment of complicated congenital scoliosis: report of 2 cases

Objective To explore the feasibility and the clinical curative effect of staging surgery for pediatric complicated congenital scoliosis.Methods A retrospective study was made for 2 cases of pediatric complicated congenital scoliosis had received staging surgery from July 2006 to January 2013. The pre-operative and postoperative parameters such as coronal and sagittal balance, coronal Cobb angle, shoulder balance were measured to evaluate the therapeutic effect.Results Case A had been improved its Cobb angle from pre-operative 78° to postoperative 40° and been decreased the height difference of scapulas to 6 cm in first stage surgery, further improvement had been made for the Cobb angle was to 16° and the height difference of scapulas was to 5 cm in second stage surgery. From 6 to 8 years after surgery, the Cobb angle had been continuously improved to 16° and 10°. Case B had been improved its Cobb angle of main thoracic scoliosis from pre-operative 53° to postoperative 11°, and the lumber scoliosis had been improved from 31° to 21°, and the height difference of scapulas had been decreased to 6 cm in the first stage surgery, 1 year later lumber scoliosis increased to 30 ° and there was 8 cm coronal imbalance developed. After second stage surgery the distance from C₇PL to CSVL decreased to 4 cm, and the lumber Cobb angle decreased to 3°, 1 year after the second stage surgery the lumber Cobb angle had continuously improved to 1 °, distance from C₇PL to CSVL continuously decreased to 3 cm. There were no surgical complications in both cases.Conclusions Staging surgery for complicated pediatric congenital scoliosis surgery is more practical, lower risk, and better outcome.