一期后路半椎体切除短节段融合术治疗先天性半椎体畸形的多中心研究OA北大核心CSTPCD
Efficacy of one-stage posterior hemivertebrectomy and short segment fusion for congenital hemivertebra malformations:a multicenter clinical study
目的 采用多中心研究方案,评价一期后路半椎体切除、短节段融合术治疗先天性半椎体畸形的效果.方法 本研究为回顾性研究,参与单位包括深圳市儿童医院等6个医疗中心.2016年5月至2021年3月6个医疗中心共采用手术治疗单个胸椎或腰椎半椎体畸形所致先天性脊柱侧凸患儿35例,随访时间均在2年以上,均采用后路一期半椎体切除、短节段固定融合术.收集所有患儿一般资料,测量术前、术后及末次随访时冠状面主弯Cobb角、头侧代偿弯、尾侧代偿弯、冠状面平衡和矢状面节段性后凸角度以及并发症情况,评价手术效果.结果 35例患儿中,男18例,女17例,其中半椎体位于第2至第10胸椎者10例,位于第11胸椎至第2腰椎者17例,位于第3至第5腰椎者8例.平均固定融合2.4个脊柱节段,手术年龄(4.5±2.6)岁,随访时间(42.6±17.6)个月;冠状面主弯Cobb角:术前为(37.6±9.0)°,术后为(9.0±6.4)°,末次随访时为(13.3±11.1)°.术后畸形矫正率为76.1％,末次随访时畸形矫正率为64.6％.头、尾侧代偿弯自行矫正率分别为44.4％和57.1％,节段性后凸矫正率为37.2％.术后及末次随访时的主弯、头侧代偿弯、尾侧代偿弯及节段性后凸角度与术前相比,差异均有统计学意义(P＜0.05).并发症:椎弓根切割4例(11.4％,4/35),畸形进展3例(8.6％,3/35),感染1例(2.9％,1/35),无一例神经系统并发症.结论 后路一期半椎体切除、短节段融合术治疗单个胸椎或腰椎半椎体畸形所致先天性脊柱侧凸安全有效,能直接去除致畸原因,保留脊柱生长与活动功能,但需重点关注和积极预防椎弓根切割、畸形进展等术后并发症.
Objective To evaluate the efficacy of one-stage posterior hemivertebrectomy and short seg-ment fusion for congenital hemivertebra deformity in children at multiple medical centers.Methods This ret-rospective study included 35 children with single-level thoracic or lumbar hemivertebra who undergoing one-stage posterior hemivertebrectomy and short segment fusion at six medical centers between May 2016 and March 2021.The follow-up period was at least 2 years.General profiles,measurements of coronal main curve Cobb an-gle,proximal compensatory curve,distal compensatory curve,coronal balance,sagittal segmental kyphosis angle and complications were recorded at preoperation,postoperation and final follow-up visits for evaluating surgical outcomes.Results There were 18 boys and 17 girls with hemivertebra in T2-10(n=10),T11-L2(n=17)andL3-5(n=8).Average number of fused segments was 2.4.Operative age was(4.5±2.6)year and follow-up period(42.6±17.6)month.Preoperative coronal main curve Cobb angle was(37.6°±9.0°),post-operative angle(9.0°±6.4°)and final follow-up angle(13.3°±11.1°).Correction rates at postoperation and final follow-up were 76.1％and 64.6％.Correction rates of proximal compensatory curve and distal com-pensatory curve were 44.4％and 57.1％.Correction rate of segmental kyphosis was 37.2％.Significant differ-ences existed in postoperation and final follow-up coronal main curve Cobb angles,proximal compensatory curve,distal compensatory curve and sagittal segmental kyphosis angle as compared with preoperative values(P＜0.05).Complications included pedicle cutting(11.4％,4/35),deformity progression(8.6％,3/35)and infection(2.9％,1/35).No neurological complication was reported.Conclusions One-stage posterior hemivertebrectomy and short segment fusion are both safe and effective for treating single-level thoracic or lum-bar hemivertebra deformities in children.This surgical approach directly addresses the underlying cause of de-formity and preserves spinal growth and function.Nevertheless,meticulous cares and proactive preventions of postoperative complications,such as pedicle cutting and deformity progression,are necessary.
黄琦;唐盛平;徐江龙;宿玉玺;叶卫华;唐欣;陈顺有;周治国;赵占波;付桂兵
深圳市儿童医院骨科,深圳 518026重庆医科大学附属儿童医院骨科,重庆 400015湖南省儿童医院骨科,长沙 410007华中科技大学同济医学院附属协和医院小儿骨科,武汉 430022福州市第二总医院小儿骨科,福州 350007华中科技大学同济医学院附属武汉儿童医院骨科,武汉 430010
脊柱侧凸,先天性椎板切除术脊柱融合术治疗结果多中心研究
Scoliosis,CongenitalLaminectomySpinal FusionTreatment OutcomeMulticenter Studies as Topic
《临床小儿外科杂志》 2024 (006)
521-526 / 6
广东省高水平医院建设专项经费(粤府办[2021]6号);深圳市"医疗卫生三名工程"项目资助(SZSM202011012) Guangdong Provincial High-level Hospital Construction Project(YFB2021-6);Sanming Project of Medicine in Shenzhen Municipality(SZSM202011012)
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