凸侧骨骺阻滞术对阻止半椎体所致脊柱侧凸的进展疗效分析

目的：探讨凸侧骨骺阻滞术对先天性脊柱侧凸患者的治疗效果。方法：回顾分析1998年10月至2008年2月行Ⅰ期前后路联合骨骺阻滞术的胸腰椎半椎体畸形22例患者，其中男12例，女10例。测量术前、术后及末次随访时主弯及代偿弯角度，同时计算术后进展率及年进展量。观察侧凸进展率和年进展量与年龄、性别、半椎体数目、半椎体位置、术前主弯Cobb角及代偿弯Cobb角之间有无相关性，比较不同年龄、性别、半椎体数目、半椎体位置以及术前主弯Cobb角对术后侧弯进展的影响。结果：22例主弯Cobb角术前为（40.5±9.8）°，术后3个月为（39.5±11.1）°，末次随访时为（46.8±13.9）°。代偿弯Cobb角术前为（20.1±10.8）°，术后3个月为（23.0±11.1）°，末次随访为（29.9±11.5）°。术前主弯及代偿弯Cobb角与术后3个月比较，差异无统计学意义（P>0.05），末次随访与术前、术后3个月比较差异有统计学意义（P<0.01）。术后共有20例出现主弯角度进展，平均进展率为（19.2±17.9）%，年进展量为（1.5±1.4）°，共有20例患者出现代偿弯进展，平均进展率为（39.6±37.0）%，年进展量为（1.4±1.3）°。3例因术后侧凸进展明显行侧凸矫形内固定。22例患者手术时年龄及半椎体数分别与术后主弯进展率之间存在显著相关性，手术时年龄、主弯角度及术前代偿弯角度分别与术后主弯年进展量之间存在显著相关性（P<0.05）。结论：凸侧骨骺阻滞术不能获得即刻的矫形效果，长期随访发现，也不能有效阻止侧凸的进展，可认为凸侧骨骺阻滞术对于先天性半椎体畸形患者而言是一种无效的手术方式。

Ineffective treatment technique of convex epiphysiodesis for congenital scoliosis

Objective: To discuss the long-term outcome of convex epiphysiodesis in the treatment for congenital scoliosis (CS).Methods: The clinical data of 22 patients with hemivertebral deformity undergoing convex epiphysiodesis from the October 1998 to Febuary 2008 were respectively analyzed. There were 12 males and 10 females. The whole spine anteroposterior radiographs were taken preoperatively,at 3-month postoperatively and at the final follow-up to measure the main curve and the compensatory curve. The progression rate was calculated for each patient. Observing the correlation between the progression rate and annual progression of the scoliosis and age,gender,hemivertebral number,hemivertebral position,preoperative main curve Cobb angle and compensatory curve Cobb angle,comparing different ages,genders,hemivertebral number and position,and preoperative main curve Cobb angle on the progression of postoperative curve.Results: The mean Cobb angle of main curve changed from(40.5±9.8)° before surgery to(39.5±11.1)° at 3 months after surgery,which significantly increased to (46.8±13.9)° in the final follow-up. Meanwhile the mean Cobb angle of compensatory curve was changed from (20.1±10.8)° before surgery to (23.0±11.1)°,which significantly increased to (29.9±11.5)° in the final follow-up. There were no significant differences in the Cobb angle of the main curve and the compensatory curve between postoperative 3 months and before operation(P>0.05). The difference between the final follow-up and the preoperative,postoperative 3 months was statistically significant (P<0.01). Twenty patients experienced progression of both main curve and compensatory curve,with a mean progression rate of (19.2±17.9)% for main curve and (39.6±37.0)% for compensatory curve. The annual progression volume was (1.5±1.4)° for main curve and (1.4±1.3)° for compensatory curve. Three patients underwent lateral convex orthopedic internal fixation due to postoperative scoliosis progression. The curve progression was significantly correlated with age at the time of surgery and hemivertebral number. There was a significant correlation between the age of the operation,the main curve angle,the preoperative compensatory curve angle and the annual progression volume of the main curve(P<0.05).Conclusion: The convex epiphysiodesis technique cannot effectively prevent curve progression of CS patients in the long-term follow-up. It is not recommended to apply this technique to the treatment of patients with congenital hemivertebrae.