后路一期半椎体切除治疗胸腰椎多发半椎体脊柱畸形

目的：观察后路一期半椎体切除、内固定植骨融合术治疗胸腰椎多发半椎体脊柱畸形的临床效果。方法2005年6月至2012年12月南华大学附属第一医院收治9例胸腰椎多发半椎体畸形患儿，其中3例胸腰椎有3个半椎体畸形、6例有2个半椎体畸形，共计21个半椎体；完全分节型14个、不完全分节型7个。均行后路一期半椎体切除、内固定植骨融合术，术前、术后和定期随访时拍摄站立位脊柱正侧位片，测量冠状面侧凸Cobb角及矢状面后凸Cobb角。结果全部患者获随访7～52个月（平均24.8个月）。手术时间210～450 min （平均326 min），术中出血量1200～3800 mL（平均1950 mL）。冠状面侧凸Cobb角由术前的（47±10）°矫正至术后的（14±4）°，矢状面后凸Cobb角由术前的（28±4）°矫正至术后的（11±4）°，手术前后比较，差异有统计学意义（P＜0.05）。末次随访时冠状面和矢状面矫形丢失不明显。1例术中出现硬脊膜撕裂致术后脑脊液漏，延长伤口引流时间后痊愈；1例术后出现神经根性分布一侧下肢麻木、胀痛，随访3个月症状消失。术后6个月随访9例患者均获得植骨融合，无一例发生感染、内固定失败及假关节形成。结论对于胸腰椎多发半椎体脊柱畸形，后路一期半椎体切除、内固定植骨融合术可取得良好的临床效果。

One-stage posterior excision of hemivertebrae for the treatment of congenital thoracic-lumbar kyphoscoliosis of multiple hemivertebraes

Objective To evaluate the outcome of one-stage posterior hemivertebrae resection and internal fixation for the treatment of congenital thoracic-lumbar kyphoscoliosis of multiple hemivertebraes. Methods From June 2005 to December 2012, nine consecutive patients with thoracic-lumbar kyphoscoliosis of multiple hemivertebraes were treated in the First Affiliated Hospital of University of South China. There were a total of 21 hemivertebraes, including 3 patients with 3 hemivertebraes and 6 patients with two hemivertebraes, in which 14 fully segmented hemivertebraes and 7 incomplete segmented hemivertebraes. One-stage posterior hemivertebrae resection and internal fixation was performed in all cases. Long cassette standing radiographs were taken to measure the coronal scoliotic Cobb angle and sagittal kyphotic Cobb angle at preoperation, postoperation and the final follow-up. Results The average follow-up was 24.8 months ranging from 7 to 52 months. The average operative time was 326 min （210-450 min） with a mean 1 950 mL （1 200-3 800 mL） of estimate blood loss. The scoliosis was corrected from preoperative （47 ± 10）° to postoperative （14 ± 4）° , the kyphosis was corrected from preoperative （28 ± 4）° to postoperative （11 ± 4）° , the difference between preoperation and postoperation had statistical significance （P 〈0.05）. At the final follow-up, there was no obvious loss of correction. Leakage of cerebrospinal fluid occurred in 1 case was cured by lengthening incision drainage time, neurological deficit with numbness and distending pain in lower limb occurred in 1 case was resolved in 3 months. Bony fusion was obtained in all patients at 6 month＇s follow up. No infections, hardware failure or spinal pseudoarthrosis had happened. Conclusion One-stage posterior hemivertebrae resection and internal fixation is a reasonable surgical option for patients with congenital thoracic-lumbar kyphoscoliosis of multiple hemivertebraes.