后路半椎体切除短节段融合治疗先天性脊柱侧弯_临床医学论文.docVIP

后路半椎体切除短节段融合治疗先天性脊柱侧弯_临床医学论文 后路半椎体切除短节段融合治疗先天性脊柱侧弯_临床医学论文 作者：许伟华，杨述华，杜靖远 【摘要】 ［目的］ 探讨单纯经后方入路半椎体切除后，行短节段椎弓根螺钉矫形固定对先天性脊柱侧弯的疗效。［方法］ 21例先天性半椎体畸形的患儿，单纯经后方入路切除半椎体，并一期行后路短节段椎弓根螺钉系统矫形固定和脊柱植骨融合术，比较术前、术后和最后一次随访脊柱全长正侧位X线片，测量并记录脊柱侧弯及后凸的Cobb’s角。［结果］本组病例脊柱畸形明显改善，冠状面，半椎体节段侧弯术前平均41.5°，术后15.1°，矫正率63.6%；最后一次随访时平均14.7°，矫正64.6%；冠状面主侧弯术前平均46.9°，术后18.4°，矫正60.8%；最后一次随访时平均17.5°，矫正62.7%；矢状面，半椎体节段术前有15.4°后凸畸形，术后恢复至正常生理曲度范围。手术后头侧和尾侧代偿弯也得到明显改善。［结论］单纯后方入路切除半椎体后行短节段椎弓根螺钉系统矫形内固定术，可满意地矫正先天性脊柱侧弯，在骨骼成熟之前进行治疗可有效地预防继发性的脊柱改变。 【关键词】 先天性； 脊柱侧弯； 半椎体切除； 脊柱融合 Abstract: ［Objective］To evaluate surgical outcomes of hemivertebra resection only via posterior approaches followed by short-segment transpedicular instrumentation for correction of the congenital scoliosos. ［Method］A group of patients with a single hemivertebra between the ages 5-16 years who underwent operative treatment were evaluated. Hemivertebra resection through posterior approach and short-segment transpedicular instrumentation were used for correction of the scoliosis and kyphosis deformities. Radiographic evaluation were conducted before and after operation and at follow-up visits. Cobb’s angles of the segmental curve, total main curve, cranial and caudal compensatory curves and kyphosis were measured on the posteroanterior and lateral radiographs.［Result］The cases in this study showed satisfied results.The mean Cobb’s angle of segment curve was 41.5° before surgery and 15.1° after surgery with a 63.6% correction, and 14.7° at the lastest follow-up assessment with a 64.6% correction；total main curves improved from 46.9°to 18.4°, with a 60.8% correction；17.5°at last follow-up, with a 62.7% correction; the correction ratio for kyphosis was from 15.4°kyphosis to normal physical profile; cranial and caudal compensartory curves were obviously improved.［Conclusion］Hemivertebra resection and short-segment transpedicular instrumentation could be performed only through posterior approach, which had exerted satisfactory correction on congenital scoli