后路半椎体切除短节段固定矫正先天性脊柱侧凸畸形24例

目的:探讨一期后路半椎体切除、短节段椎弓根螺钉内固定治疗先天性脊柱侧凸的临床效果。方法:选择先天性脊柱侧凸畸形患者24例,其中完全分节性半椎体16例,半椎体伴对侧分节不全8例。手术采取一期后路半椎体切除、短节段椎弓根螺钉内固定融合矫正。结果:23例获得随访,随访时间1年6个月至7年8个月。术前侧凸Cobb’s角30~90,°平均66,°术后Cobb’s角10~28,°平均16,°矫正率为58.5%;术前后凸25~68,°平均46,°术后后凸7~16,°平均14,°矫正率为62.6%。22例均无并发症,1例半椎体切除患者术后出现同侧下肢股部麻木,伸膝肌力Ⅳ级,经营养神经等治疗1月恢复正常。结论:先天性脊柱侧凸大多数都进行性发展;一期后路半椎体切除短节段融合矫正,固定节段短,创伤小,可以起到很好的矫正效果。

One stage posterior excision of hemivertebra and short segment fixation for the treatment of congenital scoliosis

Objective：To evaluate the clinical results of one stage posterior excision of hemivertebra and short segment pedicle screw fixation in treatment of congenital scoliosis.Method：24 cases of congenital scoliosis were retrospectively analyzed.Among the patients,there were 16 cases with fully segmented hemivertebra and 8 cases with partial segmented hemivertebra.The congenital scoliosis patients were undergone one stage hemivertebra excision through open posterior approach combined with short segment pedicle screw fixation.Result： 23 cases were successfully followed.The average follow-up time was from 1 year 6 month to 7 years 8 months.The average Cobb＇s angle in coronal plane was 66°ranging from 30°to 90°preoperatively,which was corrected to average 14°ranging from 7°to 16°postoperatively.The rate of correction was 62.6%.No permanent complication was observed.1 case had numbness in homolateral thigh and Grade Ⅳ knee extension muscle strength after hemivertebra excision,which was totally recovered after 1 month of nerve nourishing treatment.Conclusion：Most congenital scoliosis has natural progressive development history.One stage posterior excision of hemivertebra combined with correction and internal fixation fused short segment and has little injury,good correction result can be expected.