后路经椎弓根儿童半椎体全切除术的近期疗效评估

Objective To evaluate the early outcomes of children with congenital scoliosis treated by one-stage transpedicular hemivertebra resection. Methods From July 2005 to June 2006, 27 consecutive cases of congenital scoliosis managed by one-stage transpedicular hemivertebra resection with instrumentation were investigated retrospectively. There were 11 girls and 16 boys, with a mean age of 5. 5 years at surgery (range 1.3-10.0 years). Location of the hemivertebra was in the thoracic spine in 12 cases and in the lumbar spine in 15 cases. Radiographic evaluations were performed on the preoperative, postoperative, and latest follow-up standing posteroanterior and lateral radiographs. Results The average operation time was 4 hours (range 3-6 hours), and the mean blood loss during operation was 750 ml (range 300-2200 ml). The mean fusion level was 2 to 7 segments, average 4. 4 segments. The average follow-up period was 16 months (range 12-34 months). Mean Cobb angle of the total main curve was 40.0° before surgery, 12. 6° after surgery, and 15. 2° at latest follow-up. Mean Cobb angle of the segmental main curve was 35. 6° before surgery, 11.6° after surgery, and 12. 1° at latest follow-up. The trunk shift was improved from 16. 5 mm before operation to that of 7. 5 mm after the operation and 7. 6 mm at the latest follow-up. Compensatory cranial curve improved from 19.4° before surgery to 8.9° after surgery, and compensatory caudal curve improved from 26. 3° to 12. 8°. The angle of segmental kyphosis was 26.4° before surgery and 14. 6° after surgery in cases with thorcic hemivertebrae, and averaged 11. 2° before surgery and 3. 9° after surgery in cases with lumbar hemivertebrae. Peri-operative complications included two pedicle screws malpositioning and one case with pelvic tilt. There was no neurological complication. Conclusion One-stage transpedicular hemivertebra resection with instrumentation has a good capability of correcting deformity on the frontal and sagittal planes, which is available in children with middle or lower thoracic or lumbar hemivertebrae.

Early outcome of one-stage posterior transpedicular hemivertebra resection in the treatment of children with congenital scoliosis