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目的:评价后路半椎体切除、短节段经椎弓根内固定术治疗幼儿先天性脊柱侧凸患者的效果。方法:2003年2月￣2003年8月,采用后路半椎体切除、短节段经椎弓根内固定术治疗18例先天性脊柱侧凸的幼儿患者,年龄3.9￣7.3岁,平均5.3岁,术后支具固定6￣8个月。术前及术后3、6、12、24个月摄站立前后位和侧位X线片。通过X线片和临床物理检查评估手术前后患者的躯干平衡和失代偿情况。结果:术前主弯Cobb角42.7°,术后16.4°,末次随访时14.1°。主弯头侧代偿弯由术前16.8°改善至5.8°,主弯尾侧代偿弯由术前25.6°改善至10.5°。所有患儿躯干平衡良好,未发现失代偿现象。术中或术后出现椎弓根螺钉割裂椎体3例。1例术后出现感染,无矫形丢失而需再次手术病例。结论:对发展的半椎体畸形,在原发弯发展严重或代偿弯形成结构性弯之前,进行后路半椎体切除、椎弓根螺钉内固定手术可以矫正和控制冠状面和矢状面畸形,短节段固定可保存脊柱的生长能力和更多的运动节段。
Objective: To evaluate the effect of posterior hemivertebra resection and short segment pedicle screw fixation in children with congenital scoliosis. Methods: From February 2003 to August 2003, 18 children with congenital scoliosis were treated with posterior hemivertebra resection and short segmental pedicle screw fixation. The average age was 3.9-7.3 years (average 5.3) Years old, postoperative brace fixed 6 to 8 months. Preoperative and postoperative 3,6,12,24 months photo taken before and after the position and lateral X-ray film. X-ray and clinical physical examination to assess the patient’s trunk balance before and after surgery and decompensation. Results: Preoperative Cobb angle 42.7 °, postoperative 16.4 °, the last follow-up 14.1 °. The correction of the main elbow side was improved from 16.8 ° before surgery to 5.8 °, while that from the anterior side 25.6 ° to 10.5 °. All children with good body balance, no decompensation was not found. There were 3 cases of pedicle screw fracture in or after operation. One case of postoperative infection, no orthopedic loss and need to re-operation cases. CONCLUSIONS: For the development of hemivertebra deformity, anterior hemivertebra resection and pedicle screw internal fixation surgery can correct and control the coronal and sagittal Facial deformity, short segment fixation can save the growth capacity of the spine and more sports segments.