儿童先天性脊柱后凸畸形截骨方式的选择及效果分析

目的探讨儿童先天性脊柱后凸畸形截骨矫形及不同类型后凸截骨方式的选择与治疗效果。方法回顾性分析2010年1月至2017年12月因先天性脊柱后凸畸形于首都医科大学附属北京儿童医院行一期后路截骨矫形内固定术患者的临床资料,共48例,其中男26例,女22例;年龄2~16岁,平均(7.6±3.8)岁。记录患者的后凸类型、截骨方式及固定节段;测量并比较术前、术后及末次随访时节段性后凸角(segmental kyphosis,SK)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)和矢状面平衡(sagittal vertical axis,SVA)情况,记录患者术中及随访期间的并发症发生情况。结果随访时间为24~108个月,平均(37.9±10.2)个月。Ⅰ型后凸19例,Ⅱ型后凸16例,Ⅲ型后凸13例。采用Ponte截骨9例,经椎间隙截骨5例,经椎弓根截骨(pedicle subtraction osteotomy,PSO)13例,SRS-Schwab 4级截骨8例,全脊椎切除(vertebra column resection,VCR)13例。术前SK为(52.3±14.3)°,TK为(11.2±13.7)°,LL为(33.2±14.3)°,SVA为(21.9±13.6)mm;术后1个月时SK为(20.0±12.1)°,TK为(26.8±10.0)°,LL为(43.5±10.4)°,SVA为(-24.0±19.1)mm;与术前相比,术后SK、TK、LL及SVA均有明显改善。末次随访时SK为(19.4±13.4)°,TK为(23.9±6.0)°,LL为(41.9±9.4)°,SVA为(-17.6±15.3)mm,与术后相比均未见明显矫正丢失。1例出现后凸矫形部分丢失,1例出现冠状面近端Adding-on,均未行翻修手术。患者随访期间未出现神经系统并发症。结论截骨手术治疗儿童先天性脊柱后凸畸形可取得较好的矫形效果,并发症较少。具体截骨方式需要根据后凸类型及程度决定,对于Ⅰ型后凸可选择Ponte截骨、SRS-Schwab 4级截骨或VCR截骨;Ⅱ型后凸可选择经椎间隙截骨、PSO截骨或SRS-Schwab 4级截骨;Ⅲ型后凸可选择PSO截骨或SRS-Schwab 4级截骨。

Clinical outcomes and osteotomic strategies for congenital kyphosis in children

Objective To explore the clinical outcomes of surgical treatment for congenital kyphosis in children and examine the optimal osteotomy options for different congenital kyphosis.Methods From January 2010 to December 2017,clinical and imaging data of 48 children with congenital kyphosis undergoing posterior surgery were reviewed.There were 26 boys and 22 girls with an average age of(7.6±3.8)(2-16)years.Classification of kyphosis,osteotomy type and fixation level were recorded.On standing whole spinal X-rays at pre/post-operation and the last follow-up,segmental kyphosis(SK),thoracic kyphosis(TK),lumbar lordosis(LL)and sagittal vertical axis(SVA)were measured.The intra-operative and post-operative complications were recorded.Results The average follow-up was(37.9±10.2)(24-108)months.The clinical types wereⅠ(n=19),Ⅱ(n=16)andⅢ(n=13).The procedures included Ponte osteotomy(n=9),intervertebral osteotomy(n=5),pedicle subtraction osteotomy(PSO,n=13),SRS-Schwab grade 4 osteotomy(n=8)and vertebra column resection(VCR,n=13).Preoperatively,the values of SK,TK,LL and SVA were(52.3±14.3)°,(11.2±13.7)°,(33.2±14.3)°and(21.9±13.6)mm;at Month 1 post-operation,SK,TK,LL and SVA were corrected to(20.0±12.1)°,(26.8±10.0)°,(43.5±10.4)°and(-24.0±19.1)mm.At the last follow-up,SK,TK,LL and SVA were(19.4±13.4)°,(23.9±6.0)°,(41.9±9.4)°and(-17.6±15.3)mm respectively.All children stayed stable during follow-ups.One patient suffered partial progression and another had coronal proximal Adding-on.Neither underwent revision.There was no neurologic complication.Conclusion Congenital kyphosis may be corrected effectively by osteotomy with fewer complications.Optimal osteotomy option depends upon kyphotic type and degree.For typeⅠkyphosis,Ponte osteotomy,SRS-Schwab Grade 4 osteotomy or VCR is performed;for typeⅡkyphosis,intervertebral osteotomy,PSO or SRS-Schwab grade 4 osteotomy;for typeⅢkyphosis,PSO or SRS-Schwab Grade 4 osteotomy.