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[目的]评价后路半椎体切除钉棒固定术治疗婴幼儿青少年先天性脊柱侧后凸畸形的临床效果。[方法]回顾性分析施行后路半椎体切除术的先天性脊柱侧后凸16例幼儿和12例青少年患者的临床资料,均行后路一期半椎体切除及钉棒固定融合术。对手术时间、术中出血量及手术前后Cobb角进行了对比研究。[结果]幼儿组患者手术时间平均185 min;术中出血量平均375 ml,平均输血量450 ml;固定节段平均5.1个椎体。青少年组患者手术时间平均275 min;术中出血量平均765 ml,平均输血量850 ml;固定节段平均8个椎体。两组患者术后随访13~26个月,平均18.5个月。站立位全脊柱正侧位X线片示侧凸Cobb角幼儿组平均为12°,平均矫正率68.4%;终末随访时侧凸Cobb角平均17°,丢失5°,平均矫正率55.3%。青少年组侧凸Cobb角平均47°,平均矫正率13.0%;终末随访时侧凸Cobb角平均48°,丢失2°。幼儿组围手术期并发症包括伤口愈合不良1例,无神经系统并发症。青少年组伤口愈合不良2例,神经损害2例。[结论]后路半椎体切除可直接去除致畸因素,后路钉棒固定在幼儿组可获得良好的矫形。青少年组患者由于脊柱侧凸僵硬,矫形不佳,并且术后患者神经损害并发症较高。因此,对于先天性半椎体脊柱侧凸患者,幼儿期即行手术矫形,可以获得较佳的治疗效果。
[Objective] To evaluate the clinical effect of posterior hemivertebra resection and pedicle screw fixation in the treatment of congenital kyphotic deformity in infants and adolescents. [Methods] The clinical data of 16 cases of congenital kyphotic kyphosis and 12 cases of adolescent patients who underwent posterior hemivertebra resection were retrospectively analyzed. The operation time, intraoperative blood loss and Cobb angle before and after surgery were compared. [Result] The average operation time of children in early childhood group was 185 min. The average amount of intraoperative blood loss was 375 ml and the average volume of blood transfusion was 450 ml. The mean vertebral body mass in fixed segment was 5.1. The operation time of the adolescent group was 275 min on average. The intraoperative blood loss was 765 ml on average, and the mean blood transfusion was 850 ml. On average, 8 vertebral bodies were fixed in the fixation group. Two groups of patients were followed up for 13 to 26 months, an average of 18.5 months. The position of the full spine posterior X-ray showed Cobb angle child group average 12 °, the average correction rate of 68.4%; terminal follow-up Cobb angle average 17 °, loss of 5 °, the average correction rate of 55.3%. The average Cobb angle in young group was 47 ° and the average correction rate was 13.0%. Cobb angle at the end of follow-up averaged 48 ° and lost 2 °. Perioperative complications in the toddler group included 1 case of poor wound healing and no neurologic complications. Adolescent group wound healing in 2 cases, 2 cases of nerve damage. [Conclusion] The posterior hemivertebra resection can directly remove the teratogenic factors, and the posterior screw-rod fixation in the pediatric group can obtain good orthopedic. Adolescent patients with scoliosis stiff, poor orthopedic, and postoperative patients with neurological complications higher. Therefore, for patients with congenital hemivertebra scoliosis, surgery in early childhood that surgery, you can get better treatment.