后路截骨短节段融合术联合双生长棒技术治疗严重僵硬先天性脊柱侧凸

 目的 评估后路截骨短节段融合术联合双棒生长棒技术治疗严重、僵硬先天性脊柱侧凸的初步疗效。方法 回顾性研究2006年至2011年行截骨短节段融合联合双棒生长棒技术治疗7例先天性脊柱侧凸患者资料，男2例，女5例；年龄2～10岁，平均5.9岁；Risser征均为0度。记录患儿年龄、撑开次数及并发症。对影像学资料进行测量分析，测量指标包括在站立位全脊柱正侧位X线片上侧凸Cobb角、胸后凸、腰前凸、T₁～S₁距离及内固定的长度，对畸形的矫正情况以及脊柱、胸廓的生长状况进行评估。结果 7例患儿共接受后路截骨短节段融合联合生长棒手术48次，其中41次为撑开术，平均每例患儿经历5.9次撑开术。7例患儿均获得随访，随访时间36～83个月，平均为59.4个月。冠状面主弯度数术前81.4° ，术后40.1° ，末次随访时41.1°。T₁～S₁从术前23.7 cm增至术后的27.0 cm，末次随访时为32.8 cm，平均年增长率为1.12 cm/年。内固定节段初次手术术后为20.5 cm，末次随访时为25.0 cm。坎贝尔的空间供肺比值（Campbell’s space available for lung ratio, SAL），术前为0.87，术后改善至0.95，末次随访时为0.97。1例患儿因脊柱生长致生长棒可撑开部分不足接受换棒术。末次随访时，无一例患儿发生并发症。结论 截骨短节段融合联合双棒生长棒技术治疗严重、僵硬先天性脊柱侧凸安全、有效，可在维持矫形的同时，保留大部分脊柱的生长潜力，但是该技术创伤较大、手术难度较高、需多次手术。

Preliminary results of osteotomy with short fusion and dual growing rod technique for congenital scoliosis

Objective To evaluate the clinical outcomes of the hybrid technique of posterior osteotomy with short segmental fusion and dual growing rod technique for severe rigid congenital scoliosis. Methods Seven patients （2males, 5 females） undergoing this hybrid technique for severe rigid congenital scoliosis in our hospital from 2006 to 2011 were retrospectively studied. The average age was 5.9 years (range, 2-10). The Risser sign of all the patients was 0. The follow-up time was 59.4 months (range, 36-83 months). The patients' charts were reviewed. The analysis included age at initial surgery and the latest follow-up, number and frequency of lengthening, and complications. Radiographic evaluation included measured changes in scoliosis Cobb angle, thoracic kyphosis, lumbar lordosis, trunk shift, length of T₁-S₁ and instrumentation. Results All patients were treated with posterior osteotomy with short segmental fusion and dual growing rod technique. There were 48 total surgeries, 41 of which were lengthening procedures, for 7 patients. The average lengthening was 5.9 per patient. The mean scoliosis improved from 81.4° to 40.1° after initial surgery and was 41.1° at the final follow-up. The average T₁-S₁ length was of 1.12 cm per year. The Campbell’s space available for lung ratio increased from 0.87 to 0.97. Conclusion Osteotomy with short fusion could help to improve the correction of the growing rod and eliminate the large asymmetric growth potential around the apex, with little influence to the length of the spine. Dual growing rod technique could maintain correction achieved at initial surgery while allowing spinal growth to continue. However, this technique is relatively more aggressive and technique demanding. And the patients need numbers of surgeries.